Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early Identification of Cerebral Large Vessel Occlusions; a Systematic Review and Meta-analysis
Introduction: Large vessel occlusion (LVO) strokes are associated with worse functional outcomes and higher mortality rates. In the present systematic review and meta-analysis, we evaluated the diagnostic yield of the Cincinnati Prehospital Stroke Scale (CPSS) in detecting LVO. Methods: We perfor...
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| Format: | Article |
| Language: | English |
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Shahid Beheshti University of Medical Sciences
2024-03-01
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| Series: | Archives of Academic Emergency Medicine |
| Subjects: | |
| Online Access: | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2242 |
| _version_ | 1797233148052897792 |
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| author | Yazdan Baser Hamed Zarei Pantea Gharin Hamid Reza Baradaran Arash Sarveazad Shayan Roshdi Dizaji Mahmoud Yousefifard |
| author_facet | Yazdan Baser Hamed Zarei Pantea Gharin Hamid Reza Baradaran Arash Sarveazad Shayan Roshdi Dizaji Mahmoud Yousefifard |
| author_sort | Yazdan Baser |
| collection | DOAJ |
| description |
Introduction: Large vessel occlusion (LVO) strokes are associated with worse functional outcomes and higher mortality rates. In the present systematic review and meta-analysis, we evaluated the diagnostic yield of the Cincinnati Prehospital Stroke Scale (CPSS) in detecting LVO.
Methods: We performed an extensive systematic search among online databases including Medline, Embase, Web of Science, and Scopus, until July 31st, 2023. We also conducted a manual search on Google and Google scholar, along with citation tracking to supplement the systematic search in retrieving all studies that evaluated the diagnostic accuracy of the CPSS in detecting LVO among patients suspected to stroke.
Results: Fourteen studies were included in the present meta-analysis. CPSS showed the sensitivity of 97% (95% CI: 87%–99%) and the specificity of 17% (95% CI: 4%–54%) at the cut-off point of ≥1. The optimal threshold was determined to be ≥2, with a sensitivity of 82% (95% CI: 74%–88%) and specificity of 62% (95% CI: 48%–74%) in detecting LVO. At the highest cut-off point of ≥3, the CPSS had the lowest sensitivity of 60% (95% CI: 51%–69%) and the highest specificity of 81% (95% CI: 71%–88%). Sensitivity analyses showed the robustness of the results regardless of study population, inclusion of hemorrhagic stroke patients, pre-hospital or in-hospital settings, and the definition of LVO.
Conclusion: A very low level of evidence demonstrated that CPSS, with a threshold set at ≥2, is a useful tool for identifying LVO stroke and directing patients to CSCs, both in prehospital and in-hospital settings.
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| first_indexed | 2024-04-24T16:11:33Z |
| format | Article |
| id | doaj.art-eab872f2452749e580bf0551184bfaf7 |
| institution | Directory Open Access Journal |
| issn | 2645-4904 |
| language | English |
| last_indexed | 2024-04-24T16:11:33Z |
| publishDate | 2024-03-01 |
| publisher | Shahid Beheshti University of Medical Sciences |
| record_format | Article |
| series | Archives of Academic Emergency Medicine |
| spelling | doaj.art-eab872f2452749e580bf0551184bfaf72024-03-31T15:05:08ZengShahid Beheshti University of Medical SciencesArchives of Academic Emergency Medicine2645-49042024-03-0112110.22037/aaem.v12i1.2242Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early Identification of Cerebral Large Vessel Occlusions; a Systematic Review and Meta-analysisYazdan Baser0Hamed Zarei1Pantea Gharin2Hamid Reza Baradaran3Arash SarveazadShayan Roshdi Dizaji4Mahmoud Yousefifard5Physiology Research Center, Iran University of Medical Sciences, Tehran, IranPhysiology Research Center, Iran University of Medical Sciences, Tehran, IranPhysiology Research Center, Iran University of Medical Sciences, Tehran, IranDepartment of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, IranPhysiology Research Center, Iran University of Medical Sciences, Tehran, IranPhysiology Research Center, Iran University of Medical Sciences, Tehran, Iran Introduction: Large vessel occlusion (LVO) strokes are associated with worse functional outcomes and higher mortality rates. In the present systematic review and meta-analysis, we evaluated the diagnostic yield of the Cincinnati Prehospital Stroke Scale (CPSS) in detecting LVO. Methods: We performed an extensive systematic search among online databases including Medline, Embase, Web of Science, and Scopus, until July 31st, 2023. We also conducted a manual search on Google and Google scholar, along with citation tracking to supplement the systematic search in retrieving all studies that evaluated the diagnostic accuracy of the CPSS in detecting LVO among patients suspected to stroke. Results: Fourteen studies were included in the present meta-analysis. CPSS showed the sensitivity of 97% (95% CI: 87%–99%) and the specificity of 17% (95% CI: 4%–54%) at the cut-off point of ≥1. The optimal threshold was determined to be ≥2, with a sensitivity of 82% (95% CI: 74%–88%) and specificity of 62% (95% CI: 48%–74%) in detecting LVO. At the highest cut-off point of ≥3, the CPSS had the lowest sensitivity of 60% (95% CI: 51%–69%) and the highest specificity of 81% (95% CI: 71%–88%). Sensitivity analyses showed the robustness of the results regardless of study population, inclusion of hemorrhagic stroke patients, pre-hospital or in-hospital settings, and the definition of LVO. Conclusion: A very low level of evidence demonstrated that CPSS, with a threshold set at ≥2, is a useful tool for identifying LVO stroke and directing patients to CSCs, both in prehospital and in-hospital settings. https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2242Brain InfarctionArterial Occlusive DiseasesClinical Decision RulesDiagnosisIntracranial ArteriosclerosisIschemic Stroke |
| spellingShingle | Yazdan Baser Hamed Zarei Pantea Gharin Hamid Reza Baradaran Arash Sarveazad Shayan Roshdi Dizaji Mahmoud Yousefifard Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early Identification of Cerebral Large Vessel Occlusions; a Systematic Review and Meta-analysis Archives of Academic Emergency Medicine Brain Infarction Arterial Occlusive Diseases Clinical Decision Rules Diagnosis Intracranial Arteriosclerosis Ischemic Stroke |
| title | Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early Identification of Cerebral Large Vessel Occlusions; a Systematic Review and Meta-analysis |
| title_full | Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early Identification of Cerebral Large Vessel Occlusions; a Systematic Review and Meta-analysis |
| title_fullStr | Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early Identification of Cerebral Large Vessel Occlusions; a Systematic Review and Meta-analysis |
| title_full_unstemmed | Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early Identification of Cerebral Large Vessel Occlusions; a Systematic Review and Meta-analysis |
| title_short | Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early Identification of Cerebral Large Vessel Occlusions; a Systematic Review and Meta-analysis |
| title_sort | cincinnati prehospital stroke scale cpss as a screening tool for early identification of cerebral large vessel occlusions a systematic review and meta analysis |
| topic | Brain Infarction Arterial Occlusive Diseases Clinical Decision Rules Diagnosis Intracranial Arteriosclerosis Ischemic Stroke |
| url | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2242 |
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