title: Improved performance of new prenotification criteria for acute stroke patients.
abstract: OBJECTIVE
  We aim to evaluate the accuracy of the new prehospital notification criteria for patients with potential acute stroke in the prehospital setting.
  
  
  METHODS
  We conducted a retrospective observational study from March 2011 to February 2013 of potential acute stroke patients prenotified using the new criteria which were: (1) positive Cincinnati Prehospital Stroke Scale (CPSS); (2) symptom onset within 3 hours; and (3) blood glucose level > 60 mg/dL. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the new criteria were calculated and outcomes of acute stroke patients were reported. Data of all patients with stroke or transient ischemic attack (TIA) transported to the destination hospital were also obtained to evaluate the compliance of emergency medical technicians.
  
  
  RESULTS
  There were 2888 patients suspected of stroke by emergency medical technicians and 221 patients prenotified due to meeting the criteria. The PPV, NPV, sensitivity, and specificity of the new criteria were 76.9%, 96.6%, 64.9%, and 98.1%, respectively. Onset time > 3 hours (24/51, 47.1%) and seizure (27.5%) were the two most common conditions leading to false prenotification. Of all prenotified patients, 23.1% (51/221) received thrombolytic therapy. Hemorrhagic stroke or ischemic stroke with hemorrhagic transformation (53.8%) and minor symptoms or rapid recovery (26.9%) were the most common reasons excluding correctly prenotified patients from thrombolytic therapy.
  
  
  CONCLUSIONS
  The accuracy of the new prehospital stroke criteria has higher PPV and specificity compared to previous CPSS validation studies.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Hsieh
authors.affiliation: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Sung-Chun
authors.initials: SC
authors.lastname: Tang
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Patrick Chow-In
authors.initials: PC
authors.lastname: Ko
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wen-Chu
authors.initials: WC
authors.lastname: Chiang
authors.affiliation: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Li-Kai
authors.initials: LK
authors.lastname: Tsai
authors.affiliation: Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States.
authors.forename: Anna Marie
authors.initials: AM
authors.lastname: Chang
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: An-Yi
authors.initials: AY
authors.lastname: Wang
authors.affiliation: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shin-Joe
authors.initials: SJ
authors.lastname: Yeh
authors.affiliation: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kuang-Yu
authors.initials: KY
authors.lastname: Huang
authors.affiliation: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: jsjeng@ntu.edu.tw.
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Jeng
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: matthew@ntu.edu.tw.
authors.forename: Matthew Huei-Ming
authors.initials: MH
authors.lastname: Ma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis*; D013624:Taiwan; D062606:Tertiary Care Centers; D015912:Thrombolytic Therapy
chemical_list: D001786:Blood Glucose
keywords: emergency medical services; prehospital stroke scale; prenotification; sensitivity and specificity; stroke care