title: Designing Iranian Pre-hospital Stroke Scale.
abstract: BACKGROUND
  Various studies have shown that stroke morbidity and mortality could be decreased if patients receive early diagnosis and treatment. Iranian Pre-hospital Stroke Scale (IPSS) is designed based on other prehospital stroke scales available across the world as well as experiences of emergency medicine specialists and pre-hospital emergency technicians to improve the diagnostic accuracy of the stroke scale in Iran.
  
  
  METHODS
  Using a mixed method, the study was carried out in two main phases. In the first phase, concept elicitation was conducted based on the review of the literature. Related stroke diagnosis and usual instruments in pre-hospital emergency stroke centers were documented. The IPSS was designed based on semi- structured interviews with 35 neurologists, emergency medicine practitioners and physicians working in hospitals and emergency technicians in the pre-hospital field. In the second phase, the face and content validity, and reliability were checked.
  
  
  RESULTS
  According to results from the first phase of this study (items generation), three domains were introduced as the most important factors in detection of early signs and symptoms of stroke. In the second phase (items reduction), the face validity of the IPSS was checked based on the comments from participants (the experts and EMS technicians). The content validity was calculated based on Lawshe index. The IPSS scale content validity index (S-CVI/Ave) was calculated as 89%. To determine the criterion validity of the instrument, the IPSS scores were compared with the final diagnosis based on results from brain CT scan in hospital.
  
  
  CONCLUSIONS
  During this study we developed IPSS to be used by emergency technicians in pre-hospital field with a dichotomous items and simple and easy administration. It is recommended for future studies to apply this tool to emergency dispatch units as well as triage procedures in hospitals.
authors: 1. BSN, MSN, Elderly Health PhD, Assistant Professor, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. asghar.dalvandi@gmail.com.
authors: Asghar
authors: A
authors: Dalvandi
authors: 2. BSN, MSN, Nursing PhD, Post Doc in Emergency and Disaster Management, Associate Professor, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Hamid.khankeh@ki.se.
authors: Hamidreza
authors: H
authors: Khankeh
authors: 3. BSN, MSN. PhD candidate in Health in Disaster & Emergencies, Nursing Department, University of Social Welfare and Rehabilitation Sciences. Tehran, Iran. s_bahrampouri@yahoo.com s_bahrampouri@yahoo.com.
authors: Saiedeh
authors: S
authors: Bahrampouri
authors: 4. BSN, MSN, Nursing PhD, Associate Professor of Behavioral Sciences Research Center (BSRC), Nursing Faculty of Baqiyatallah University of Medical Sciences. Tehran, Iran. ebadi1347@yahoo.com.
authors: Abbas
authors: A
authors: Ebadi
authors: 5. BSN, MSN, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. hojjatpassandeh@yahoo.com.
authors: Hojjat
authors: H
authors: Passandeh
authors: 6. MD, Medical Emergency Specialist, Head of Iranian EMS Office. Tehran, Iran. hassannourisari@yahoo.com.
authors: Hassan
authors: H
authors: Nouri Sari
authors: 7. MD, Associate Professor of Neurology, Arak University of Medical Sciences, Arak, Iran. fardin.faraji@yahoo.com.
authors: Fardin
authors: F
authors: Faraji
authors: 8. BSN, MSN, PhD in Biostatistics, Associate Professor of Biostatistics, Department of Biostatistics and Computer , University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. m_rahgozar2003@yahoo.com.
authors: Mehdi
authors: M
authors: Rahgozar
keywords: Iran; Iranian Pre-hospital Stroke Scale (IPSS); Pre-hospital emergency; Psychometric properties