SynthesisEmergency medicine journal : EMJ2021
Characteristics of patients who had a stroke not initially identified during emergency prehospital assessment: a systematic review.
Synthesis in Emergency medicine journal : EMJ, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 3 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Prevalence of signs and symptoms in posterior circulation ischemic stroke: a systematic review and meta-analysis.Internal and emergency medicine · 2026Pooled it
- Systematic review and meta-analysis of stroke blood biomarker data highlights need for more translational research methods.Nature communications · 2026Pooled it
- Early Recognition and Referral of Acute Stroke in Primary and Emergency Care: A Systematic Review.The western journal of emergency medicine · 2026Pooled it
- Predictors of Mortality in Posterior Circulation Ischemic Stroke.Medicina (Kaunas, Lithuania) · 2026Article
- Social Vulnerability and Out-of-Hospital Identification of Neurologic Emergencies.Annals of emergency medicine · 2026Article
- Delayed Care in Self-Presenting Stroke Patients: Real-World Data on Process Delays-Comparing Process Times Between Emergency Medical Services and Self-Presentation.Journal of clinical medicine · 2026Article
- Factors associated with missed stroke diagnosis in prehospital triage: a single-center cohort study.BMC neurology · 2026Article
- LiVE-STROKE: live video from bystander to the medical dispatcher in potential stroke cases.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- Machine learning-based identification of concomitant stroke and prognostic analysis in patients with Guillain-Barré syndrome: a retrospective study.Frontiers in immunology · 2026Article
- Diagnostic challenges in posterior circulation ischemic stroke presenting with acute dizziness and vertigo.Frontiers in neurology · 2026Review
- Pre-hospital THRIVE score predicts the thrombolysis in cerebral infarction outcome post endovascular thrombectomy: an emergency medical service study.BMC emergency medicine · 2025Article
- Health and economic benefits of improving pre-hospital identification of stroke in Australian women: a modelling study.The Medical journal of Australia · 2025Article
- Response to Comment on "Symptoms, Imaging Features, Treatment Decisions, and Outcomes of Patients with Top of the Basilar Artery Syndrome: Experiences from a Comprehensive Stroke Center".Neurocritical care · 2025Article
- [Diagnostic tools for stroke detection-from prehospital to diagnosis].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Article
- Acute vestibular syndrome induced by supratentorial stroke: clinical features and network compensation mechanisms.Frontiers in neurology · 2025Article
- Methods for improving the identification of acute stroke during ambulance calls: A scoping review.PloS one · 2025Article
- A Two-Step Approach Using the National Health Institutes of Health Stroke Scale Assessed by Paramedics to Enhance Prehospital Stroke Detection: A Case Report and Concept Proposal.Journal of clinical medicine · 2024Article
- FAST4D-A New Score to Reduce Missed Strokes in Emergency Medical Service: A Prospective, Multicentric Observational Proof-of-Concept Trial.Journal of clinical medicine · 2024Article
- Detecting Stroke at the Emergency Department by a Point of Care Device: A Multicenter Feasibility Study.Medical devices (Auckland, N.Z.) · 2024Article
- Paramedic recognition of posterior circulation stroke: a vignette and focus group study.British paramedic journal · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAround 25% of patients who had a stroke do not present with typical 'face, arm, speech' symptoms at onset, and are challenging for emergency medical services (EMS) to identify. The aim of this systematic review was to identify the characteristics of acute stroke presentations associated with inaccurate EMS identification (false negatives).
methodWe performed a systematic search of MEDLINE, EMBASE, CINAHL and PubMed from 1995 to August 2020 using key terms: stroke, EMS, paramedics, identification and assessment. Studies included: patients who had a stroke or patient records; ≥18 years; any stroke type; prehospital assessment undertaken by health professionals including paramedics or technicians; data reported on prehospital diagnostic accuracy and/or presenting symptoms. Data were extracted and study quality assessed by two researchers using the Quality Assessment of Diagnostic Accuracy Studies V.2 tool.
resultsOf 845 studies initially identified, 21 observational studies met the inclusion criteria. Of the 6934 stroke and Transient Ischaemic Attack patients included, there were 1774 (26%) false negative patients (range from 4 (2%) to 247 (52%)). Commonly documented symptoms in false negative cases were speech problems (n=107; 13%-28%), nausea/vomiting (n=94; 8%-38%), dizziness (n=86; 23%-27%), changes in mental status (n=51; 8%-25%) and visual disturbance/impairment (n=43; 13%-28%).
conclusionSpeech problems and posterior circulation symptoms were the most commonly documented symptoms among stroke presentations that were not correctly identified by EMS (false negatives). However, the addition of further symptoms to stroke screening tools requires valuation of subsequent sensitivity and specificity, training needs and possible overuse of high priority resources.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.