Dispatcher Stroke Recognition Using a Stroke Screening Tool: A Systematic Review

2016 ◽  
Vol 42 (5-6) ◽  
pp. 370-377 ◽  
Author(s):  
John Adam Oostema ◽  
Trevor Carle ◽  
Nadine Talia ◽  
Mathew Reeves
Keyword(s):  
Systematic Review ◽  
Acute Stroke ◽  
Screening Tool ◽  
Screening Tools ◽  
Primary Study ◽  
Stroke Treatment ◽  
Emergency Calls ◽  
Screening Algorithm ◽  
Reported Data ◽  
Emergency Dispatchers

Background: Emergency dispatchers represent the first point of contact for patients activating an acute stroke response. Accurate dispatcher stroke recognition is associated with faster emergency medical services response time; however, stroke is often unrecognized during initial emergency calls. Stroke screening tools such as the Cincinnati Prehospital Stroke Scale have been shown to improve on-scene stroke recognition and thus have been proposed as a means to improve dispatcher accuracy. We conducted a systematic review of the accuracy of emergency dispatcher stroke recognition when employing stroke screening tools. Methods: We conducted a comprehensive search of Medline, EMBASE, CINAHL, and Cochrane databases to identify studies of dispatcher stroke recognition accuracy. Those that specifically reported dispatcher utilization of any validated stroke screening tools in isolation or in the context of a comprehensive screening algorithm such as the Medical Priority Dispatch System (MPDS) were potentially eligible. Studies that reported data sufficient for calculation of dispatcher sensitivity or positive predictive value (PPV) using a hospital-based stroke/transient ischemic attack diagnosis as the reference standard were included. Two independent reviewers determined study eligibility, assessed quality using the QUADAS 2 instrument, and abstracted data. Results: We identified 1,413 potential studies; 54 underwent full text review. Three retrospective and 4 prospective cohort studies enrolling a total of 16,382 patients met the inclusion criteria. Stroke screening tools included MPDS (n = 4), Face Arm Speech Time (n = 2), and a novel screening algorithm developed after analysis of emergency calls for stroke (n = 1). Regardless of the screening tool employed, dispatcher stroke recognition sensitivity was suboptimal (5 studies, range 41-83%) as was the PPV (7 studies, range 42-68%). Primary study limitations included application of variable reference standards and questions regarding exclusion of subjects. No studies directly compared stroke screening algorithms and no studies specifically examined stroke recognition among potential candidates for acute stroke therapies. Conclusion: Even when utilizing a stroke screening tool, the accuracy of stroke recognition by emergency dispatchers was suboptimal. More research is needed to identify the causes of poor dispatcher stroke recognition and should focus on potential candidates for time-dependent stroke treatment.

scholarly journals Psoriatic arthritis screening: a systematic review and meta-analysis

Rheumatology ◽  
2018 ◽  
Vol 58 (4) ◽  
pp. 692-707 ◽  
Author(s):  
Nicolas Iragorri ◽  
Glen Hazlewood ◽  
Braden Manns ◽  
Vishva Danthurebandara ◽  
Eldon Spackman
Keyword(s):  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Sensitivity And Specificity ◽  
Screening Tool ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Screening Tools ◽  
Screening Questionnaire ◽  
Psa Screening ◽  
Early Psoriatic Arthritis

Abstract Objective To systematically review the accuracy and characteristics of different questionnaire-based PsA screening tools. Methods A systematic review of MEDLINE, Excerpta Medical Database, Cochrane Central Register of Controlled Trials and Web of Science was conducted to identify studies that evaluated the accuracy of self-administered PsA screening tools for patients with psoriasis. A bivariate meta-analysis was used to pool screening tool-specific accuracy estimates (sensitivity and specificity). Heterogeneity of the diagnostic odds ratio was evaluated through meta-regression. All full-text records were assessed for risk of bias with the QUADAS 2 tool. Results A total of 2280 references were identified and 130 records were assessed for full-text review, of which 42 were included for synthesis. Of these, 27 were included in quantitative syntheses. Of the records, 37% had an overall low risk of bias. Fourteen different screening tools and 104 separate accuracy estimates were identified. Pooled sensitivity and specificity estimates were calculated for the Psoriatic Arthritis Screening and Evaluation (cut-off = 44), Psoriatic Arthritis Screening and Evaluation (47), Toronto Psoriatic Arthritis Screening (8), Psoriasis Epidemiology Screening Tool (3) and Early Psoriatic Arthritis Screening Questionnaire (3). The Early Psoriatic Arthritis Screening Questionnaire reported the highest sensitivity and specificity (0.85 each). The I2 for the diagnostic odds ratios varied between 76 and 90.1%. Meta-regressions were conducted, in which the age, risk of bias for patient selection and the screening tool accounted for some of the observed heterogeneity. Conclusions Questionnaire-based tools have moderate accuracy to identify PsA among psoriasis patients. The Early Psoriatic Arthritis Screening Questionnaire appears to have slightly better accuracy compared with the Toronto Psoriatic Arthritis Screening, Psoriasis Epidemiology Screening Tool and Psoriatic Arthritis Screening and Evaluation. An economic evaluation could model the uncertainty and estimate the cost-effectiveness of PsA screening programs that use different tools.

Abstract 352: Early Data From an Implementation Science Study Suggests the Need for Identification and Adoption of Best Practices to Improve the Timeliness of Stroke Treatment

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Lisa M Monk
Keyword(s):  
Best Practices ◽  
Acute Stroke ◽  
Care Delivery ◽  
Stroke Care ◽  
Early Data ◽  
Screening Tools ◽  
Stroke Severity ◽  
Ct Scanner ◽  
Acute Stroke Care ◽  
Stroke Treatment

There is a disconnect from discovery of best treatment options and application into clinical practice in a timely manner. The I M plementation of best Pr actices f O r acute stroke care-de v eloping and optimizing regional systems of Stroke Care (IMPROVE Stroke Care) goal is to develop a regional integrated stroke system that identifies, classifies, and treats patients with acute ischemic stroke more rapidly and effectively with reperfusion therapy. These improvements in acute stroke care delivery are expected to result in lower mortality, fewer recurrent strokes, and improved long term functional outcomes. Recent discoveries in stroke care and advancement in technology extends the window for both TPA administration and mechanical thombectomy. The challenge of implementing these latest advances are difficult considering the ability of hospitals to implement the original American Heart Association (AHA) Systems of Stroke Care recommendations. Early data from this project shows that the challenges continue to exist in recommendations that have been in place as early as 2005. EMS is not utilizing pre-hospital stroke screening tools, only 5% of the time, stroke severity tools, only 7% of the time, lytic checklists, 0% of the time, destination decision changed due to severity score, 0% of the time, and pre-notifying emergency rooms, only 63% of the time. Emergency departments door to CT <45 minutes, only 55% of the time, Lytic given in CT scanner, only 35% of the time, Door to lytic therapy< 45 minutes, 77% of the time, Door to Groin puncture, 81% of the time, and Door to TICI Flow 2c/3 flow <90 minutes, 39% of the time. The Systems of Stroke Care have recommendations that will improve time to treatment and outcomes for patients. This project is working to provide tools, guidance, data, and feedback to improve application of these recommendations and identify best practices and solutions to barriers.

Artificial intelligence to diagnose ischemic stroke and identify large vessel occlusions: a systematic review

2019 ◽  
Vol 12 (2) ◽  
pp. 156-164 ◽  
Author(s):  
Nick M Murray ◽  
Mathias Unberath ◽  
Gregory D Hager ◽  
Ferdinand K Hui
Keyword(s):  
Artificial Intelligence ◽  
Machine Learning ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Feature Detection ◽  
Performance Metrics ◽  
Large Vessel ◽  
Image Feature ◽  
Stroke Treatment

Background and purposeAcute stroke caused by large vessel occlusions (LVOs) requires emergent detection and treatment by endovascular thrombectomy. However, radiologic LVO detection and treatment is subject to variable delays and human expertise, resulting in morbidity. Imaging software using artificial intelligence (AI) and machine learning (ML), a branch of AI, may improve rapid frontline detection of LVO strokes. This report is a systematic review of AI in acute LVO stroke identification and triage, and characterizes LVO detection software.MethodsA systematic review of acute stroke diagnostic-focused AI studies from January 2014 to February 2019 in PubMed, Medline, and Embase using terms: ‘artificial intelligence’ or ‘machine learning or deep learning’ and ‘ischemic stroke’ or ‘large vessel occlusion’ was performed.ResultsVariations of AI, including ML methods of random forest learning (RFL) and convolutional neural networks (CNNs), are used to detect LVO strokes. Twenty studies were identified that use ML. Alberta Stroke Program Early CT Score (ASPECTS) commonly used RFL, while LVO detection typically used CNNs. Image feature detection had greater sensitivity with CNN than with RFL, 85% versus 68%. However, AI algorithm performance metrics use different standards, precluding ideal objective comparison. Four current software platforms incorporate ML: Brainomix (greatest validation of AI for ASPECTS, uses CNNs to automatically detect LVOs), General Electric, iSchemaView (largest number of perfusion study validations for thrombectomy), and Viz.ai (uses CNNs to automatically detect LVOs, then automatically activates emergency stroke treatment systems).ConclusionsAI may improve LVO stroke detection and rapid triage necessary for expedited treatment. Standardization of performance assessment is needed in future studies.

scholarly journals Dysphagia screening tools for acute stroke patients available for nurses: A systematic review

2019 ◽  
Author(s):  
Isabel de Jesus Oliveira ◽  
Liliana Andreia Neves Da Mota ◽  
Susana Vaz Freitas ◽  
Pedro Lopes Ferreira
Keyword(s):  
Systematic Review ◽  
Acute Stroke ◽  
Methodological Quality ◽  
Selection Index ◽  
Significant Proportion ◽  
Screening Tools ◽  
Quality Analysis ◽  
Diagnostic Process ◽  
Index Test ◽  
Stroke Patients

Background & Aim: There is a high incidence of dysphagia after stroke that, depending on the assessment, methodology and time elapsed, can range from 8.1% to 80%. Early and systemic dysphagia screening is associated with a decreased risk of aspiration pneumonia and prevents inadequate hydration/nutrition. The purpose of this systematic review was to identify dysphagia screening tools for acute stroke patients available for nurses validated against reference test. The research question was: which dysphagia screening tools for acute stroke patients available for nurses? Methods & Materials: Three electronic databases were searched from January 2007 to November 2017: on PubMed, Scielo and CINAHL Plus. Two independent reviewers screened all titles and abstracts, assessed methodological quality and extracted data. The methodological quality analysis and evaluation was guided according to four domains: patient selection, index test, reference standard and flow and timing. Divergences between reviewers in data extraction were consensualized through discussion. Results: From the 377 articles retrieved, only three articles met criteria for review: Barnes-Jewish Hospital-Stroke Dysphagia Screen; the Gugging Swallowing Screen and, The Toronto Bedside Swallowing Screening Test. None of the screening tools complies with all psychometric properties, which means that a still significant proportion of patients will be kept nil by mouth without being necessary or that some patients will “fall through the cracks” interrupting the diagnostic process. The tools identified are different from each other, making their comparison impracticable. Conclusion: Due to psychometric proprieties and dietary recommendations adjusted to dysphagia severity, of all available tools, GUSS is a suitable screening tool for nurses in clinical practice.  

scholarly journals Minocycline for acute stroke treatment: a systematic review and meta-analysis of randomized clinical trials

2018 ◽  
Vol 265 (8) ◽  
pp. 1871-1879 ◽  
Author(s):  
Konark Malhotra ◽  
Jason J. Chang ◽  
Arjun Khunger ◽  
David Blacker ◽  
Jeffrey A. Switzer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Acute Stroke ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Stroke Treatment ◽  
Acute Stroke Treatment

scholarly journals Neutrophil to Lymphocyte Ratio in Preeclampsia

2021 ◽  
pp. 115-118
Author(s):  
Alfian Prasetyo ◽  
Sheella Rima Bororing ◽  
Yuma Sukadarma
Keyword(s):  
Systematic Review ◽  
Diagnostic Criteria ◽  
Screening Tool ◽  
Neutrophil To Lymphocyte Ratio ◽  
Screening Tools ◽  
P Value ◽  
Lymphocyte Ratio

Abstract Objective: To determine the correlation between neutrophil to lymphocyte ratio and preeclampsia. To determine whether neutrophil to lymphocyte ratio can be used as a screening tool for preeclampsia.Methods: This study was conducted with a systematic review method. Articles that had been gathered and filtered were reviewed by QUADAS-2 tool. Guidelines from the American Congress of Obstetricians and Gynecologists (ACOG) and Pedoman Nasional Pelayanan Kedokteran were used as a diagnostic criteria for determining preeclampsiaResults: Studies conducted by Kirbas et al, Cakmak et al, Wang et al and Panwar et al stated that there is a correlation between neutrophil to lymphocyte ratio to preeclampsia (p-value < 0.05). Cut-off values are diverse between 3.5 - 5.6 with different sensitivity and specificity.Conclusion: This systematic review shows that there is a relationship between neutrophil to lymphocyte ratio and preeclampsia. Neutrophil to lymphocyte ratio can be used as screening tools for preeclampsia in the first trimester.Keywords: neutrophil to lymphocyte ratio, NLR, preeclampsia. Abstrak Tujuan: Mengetahui apakah terdapat hubungan antara rasio neutrofil terhadap limfosit dengan preeklampsia. Mengetahui apakah rasio neutrofil terhadap limfosit dapat dijadikan sebagai alat bantu skrining preeklampsia.Metode: Penelitian ini dilakukan dengan metode systematic review. Artikel yang disaring akan ditentukan kualitasnya menggunakan QUADAS-2. Kriteria diagnostik preeklampsia yang digunakan adalah American College of Obstetricians and Gynecologists (ACOG) untuk penelitian luar negeri dan Pedoman Nasional Pelayanan Kedokteran untuk penelitian dalam negeri.Hasil : Penelitian yang dilakukan oleh Kirbas et al, Cakmak et al, Wang et al, dan Panwar et al menyatakan bahwa terdapat hubungan antara rasio neutrofil terhadap limfosit dengan preeklampsia ( p-value < 0.05). Nilai cutoff dari rasio neutrofil terhadap preeklampsia beragam mulai dari 3.5 - 5.6 dengan sensitivitas dan spesifisitas yang berbeda-beda.Kesimpulan : Penelitian systematic review ini menunjukan bahwa rasio neutrofil terhadap limfosit memiliki hubungan dengan penyakit preeklampsia. Rasio neutrofil terhadap limfosit dapat dijadikan sebagai alat bantu skrining untuk preeklampsia pada trimester pertama.Kata kunci: rasio neutrofil terhadap Limfosit, NLR, preeklamsia.

scholarly journals Ischemic stroke in Morocco: A systematic review

2019 ◽  
Author(s):  
Ahmed Kharbach ◽  
Obtel Majdouline ◽  
Laila Lahlou ◽  
Jehanne Aasfara ◽  
Nour Mekaoui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Mortality Rate ◽  
Acute Stroke ◽  
Influential Factors ◽  
Stroke Treatment ◽  
Male Predominance ◽  
Prehospital Delay ◽  
Acute Stroke Treatment

Abstract Background: The aim of this systematic review is to determine; the epidemiological and etiological profiles, the influential factors of the prehospital delay, thrombolysis management, the acute and 3-month mortality rate and the genetic aspect of ischemic stroke in Morocco.Methods: The present work is a systematic review that was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analysis". We used Pubmed, Sciencedirect, Scopus, Clinicalkey, and Google scholar databases for the raking of the gray literature during the period between 2009 and 2018. The protocol of the review was registered in the PROSPERO register (CRD42018115206). These studies were analyzed based on: Age, sex ratio, risk factors, etiological profile according to Trial of ORG classification 10172 in Acute Stroke Treatment, prehospital delay average and it’s influential factors, thrombolyzed patients proportion, acute and 3-month mortality and the genetic factors of ischemic stroke in Morocco. Results: Twenty-nine (n = 29) studies were selected. The average age ranged from 49±15.2 to 67.3 ± 9.9 years old. Moreover, we reported male predominance within all ages in 13 studies. High blood pressure, diabetes, smoking and heart disease were the four identified main risk factors by these studies. Atherosclerosis and cardioembolic were the main described etiologies of cerebral ischemia, and the average prehospital time ranged from 26 to 61.9 hours. The proportion of thrombolysed patients ranged from 1.8% to 2.9%, the mortality rate varied in the acute phase from 3 to 13%, and the 3-month mortality ranged from 4.3 to 32.5%. It is also important to highlight that most of these studies have a reduced sample size, conducted in hospital environment, and no confidence interval was reported. Conclusions: Ischemic stroke is affecting more likely the young population with male predominance. Moreover, the long prehospital delay and the low proportion of thrombolysed patients are alarming. Indicating, thus, the need to investigate in depth the key factors influencing the access to care for Moroccan patients in order to improve the management of this neurologic deficit in Morocco. Key words: Ischemic stroke, Trial of ORG classification 10172 in Acute Stroke Treatment classification, prehospital delay, thrombolysis, Morocco.

scholarly journals Measurement of Oxygen Desaturation Is Not Useful for the Detection of Aspiration in Dysphagic Stroke Patients

2017 ◽  
Vol 7 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Thomas Marian ◽  
Jens Schröder ◽  
Paul Muhle ◽  
Inga Claus ◽  
Stephan Oelenberg ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Screening Tool ◽  
Oxygen Desaturation ◽  
Screening Tools ◽  
Endoscopic Evaluation ◽  
National Guidelines ◽  
Stroke Patients ◽  
Severe Dysphagia ◽  
A Minor ◽  
Swallowing Assessment

Background: Dysphagia is one of the most dangerous symptoms of acute stroke. Various screening tools have been suggested for the early detection of this condition. In spite of conflicting results, measurement of oxygen saturation (SpO2) during clinical swallowing assessment is still recommended by different national guidelines as a screening tool with a decline in SpO2 ≥2% usually being regarded as a marker of aspiration. This paper assesses the sensitivity of SpO2 measurements for the evaluation of aspiration risk in acute stroke patients. Methods: Fifty acute stroke patients with moderate to severe dysphagia were included in this study. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardised protocol. Blinded to the results of FEES, SpO2 was monitored simultaneously. The degree of desaturation during/after swallows with aspiration was compared to the degree of desaturation during/after swallows without aspiration in a swallow-to-swallow analysis of each patient. To minimise potential confounders, every patient served as their control. Results: In each subject, a swallow with and a swallow without aspiration were analysed. Overall, aspiration seen in FEES was related to a minor decline in SpO2 (mean SpO2 without aspiration 95.54 ± 2.7% vs. mean SpO2 with aspiration 95.28 ± 2.7%). However, a significant desaturation ≥2% occurred only in 5 patients during/after aspiration. There was no correlation between aspiration/dysphagia severity or the amount of aspirated material and SpO2 levels. Conclusions: According to this study, measurement of oxygen desaturation is not a suitable screening tool for the detection of aspiration in stroke patients.

scholarly journals Accuracy of Depression Screening Tools to Detect Major Depression in Children and Adolescents: A Systematic Review

2016 ◽  
Vol 61 (12) ◽  
pp. 746-757 ◽  
Author(s):  
Michelle Roseman ◽  
Lorie A. Kloda ◽  
Nazanin Saadat ◽  
Kira E. Riehm ◽  
Abel Ickowicz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lower Bound ◽  
Children And Adolescents ◽  
Screening Tool ◽  
Diagnostic Interview ◽  
Small Sample ◽  
Screening Tools ◽  
Depression Screening ◽  
Screening Programs ◽  
Small Sample Sizes

Objective: Depression screening among children and adolescents is controversial, and no clinical trials have evaluated benefits and harms of screening programs. A requirement for effective screening is a screening tool with demonstrated high accuracy. The objective of this systematic review was to evaluate the accuracy of depression screening instruments to detect major depressive disorder (MDD) in children and adolescents. Method: Data sources included the MEDLINE, MEDLINE In-Process, EMBASE, PsycINFO, HaPI, and LILACS databases from 2006 to September 30, 2015. Eligible studies compared a depression screening tool to a validated diagnostic interview for MDD and reported accuracy data for children and adolescents aged 6 to 18 years. Risk of bias was assessed with QUADAS-2. Results: We identified 17 studies with data on 20 depression screening tools. Few studies examined the accuracy of the same screening tools. Cut-off scores identified as optimal were inconsistent across studies. Width of 95% confidence intervals (CIs) for sensitivity ranged from 9% to 55% (median 32%), and only 1 study had a lower bound 95% CI ≥80%. For specificity, 95% CI width ranged from 2% to 27% (median 9%), and 3 studies had a lower bound ≥90%. Methodological limitations included small sample sizes, exploratory data analyses to identify optimal cut-offs, and the failure to exclude children and adolescents already diagnosed or treated for depression. Conclusions: There is insufficient evidence that any depression screening tool and cut-off accurately screens for MDD in children and adolescents. Screening could lead to overdiagnosis and the consumption of scarce health care resources.

scholarly journals A Systematic Review of Validated Screening Tools for Anxiety Disorders and PTSD in Low to Middle Income Countries

2020 ◽  
Author(s):  
Anisa Mughal ◽  
Jackson Devadas ◽  
Eric Ardman ◽  
Brooke Levis ◽  
Vivian F Go ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anxiety Disorders ◽  
Screening Tool ◽  
Meta Analysis ◽  
Screening Tools ◽  
Clinical Population ◽  
Post Traumatic Stress ◽  
Middle Income ◽  
Middle Income Countries ◽  
Life Years

Abstract Background: Anxiety and post-traumatic stress disorder (PTSD) contribute significantly to disability adjusted life years in low- to middle-income countries (LMICs). Screening has been proposed to improve identification and management of these disorders, but little is known about the validity of screening tools for these disorders. We conducted a systematic review of validated screening tools for detecting anxiety and PTSD in LMICs. Methods: MEDLINE, EMBASE, Global Health and PsychINFO were searched (inception-January 10, 2019). Eligible studies (1) screened for anxiety disorders and/or PTSD; (2) reported sensitivity and specificity for a given cut-off value; (3) were conducted in LMICs; and (4) compared screening results to diagnostic classifications based on a reference standard. Screening tool, cut-off, disorder, region, country, and clinical population were extracted for each included study. We assed quality using a modified version of Greenhalgh’s ten item checklist. Accuracy results were organized based on screening tool, cut-off, and specific disorder. Accuracy estimates for the same cut-off for the same screening tool and disorder were combined via meta-analysis.ResultsOf 5343 unique citations identified, 57 articles including 75 screening tools were included. There were 44, 20 and 11 validations for anxiety, PTSD, and combined depression and anxiety, respectively. Continentally, Asia had the most validations (34). Regionally, South Asia (10) had the most validations, followed by West Asia (9) and South Africa (9). The Kessler-10 (7) and the Generalized Anxiety Disorder-7 item scale (GAD-7) (6) were the most commonly validated tools for anxiety disorders, while the Harvard Trauma Questionnaire (3) and Posttraumatic Diagnostic Scale (3) were the most commonly validated tools for PTSD. Most studies (27) had the lowest quality rating (unblinded) followed by good (21). Due to incomplete reporting, we combined only two sets of accuracy values in meta-analysis (GAD-7 cut-off ≥10; sensitivity: 76%, specificity: 64%).ConclusionUse of brief screening instruments can bring much needed attention and research opportunities to various at-risk LMIC populations, yet many have been validated in inadequately designed studies. Locally validated screening tools for anxiety and PTSD need further evaluation and well-designed studies, including clinical trials, to determine whether their use can reduce the burden of disease. PROSPERO registry number: CRD42019121794

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