SynthesisJournal of evaluation in clinical practice2026
Health Economic & Implementation Determinants of Prehospital Stroke Triage Tools: A Systematic Review.
Synthesis in Journal of evaluation in clinical practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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Authors and funding
11 authors.
Funding
Abstract
rationaleEffective prehospital stroke triage enables faster treatment and better patient outcomes. Although prehospital triage innovations are rapidly emerging, evidence regarding the balance between costs and benefits as well as implementation issues remains limited. AIMS AND
objectivesThis review aims to synthesise published evidence on health economics and implementation determinants of prehospital triage tools for acute suspected ischaemic stroke patients.
methodA systematic search was conducted across five databases (CINAHL, Cochrane, EMBASE, PubMed, and Web of Science) between 1995 and 2025. Results were reported narratively, and reporting quality was assessed using CHEERS, STROBE-simulation, COREQ, CONSORT, SQUIRE, and GRAMMS. Included were empirical studies of EMS-operated prehospital triage innovations for acute suspected stroke patients. The main outcome measures were health economic outcomes (e.g., ICER) and system-level implementation determinants (CFIR constructs).
resultsFrom 6491 screened studies, thirty-one were included: thirteen studies included health economic outcomes and eighteen reported implementation determinants. Prehospital triage tools assessed were: MSU (n = 14), telemedicine (n = 13), clinimetrics (n = 1), prehospital MRI (n = 1), biomarkers (n = 1), and an AI-based microwave tool (n = 1). Most studies (68%) were of high reporting quality. Positive results regarding cost-effectiveness were reported (n = 11), including cost-savings (n = 1), as well as implementation determinants (n = 11). However, evidence on sustained implementation was limited. Barriers included innovation design, complexity, workflow compatibility, work and IT infrastructure, and costs.
conclusionIncluded studies suggest most prehospital stroke triage tools are cost-effective, but implementation remains largely context-dependent. Barriers, including innovation complexity, role delineation, workflow fit, design, and costs, highlight the need for future studies to integrate health economics into an implementation science framework alongside clinical outcomes.
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