Improved performance of new prenotification criteria for acute stroke patients

Ming Ju Hsieh, Sung Chun Tang, Patrick Chow In Ko, Wen Chu Chiang, Li Kai Tsai, Anna Marie Chang, An Yi Wang, Shin Joe Yeh, Kuang Yu Huang, Jiann Shing Jeng, Matthew Huei Ming Ma

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Background/purpose: 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. Conclusion: The accuracy of the new prehospital stroke criteria has higher PPV and specificity compared to previous CPSS validation studies.

Original languageEnglish
Pages (from-to)257-262
Number of pages6
JournalJournal of the Formosan Medical Association
Issue number4
Publication statusPublished - Apr 1 2016
Externally publishedYes


  • Emergency medical services
  • Prehospital stroke scale
  • Prenotification
  • Sensitivity and specificity
  • Stroke care

ASJC Scopus subject areas

  • General Medicine


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