Introduction: Emergency dispatchers are usually the first contact point for stroke patients accessing the healthcare system. Dispatcher stroke recognition is associated with better paramedic stroke recognition and faster emergency medical services (EMS) response time, but stroke is often unrecognized during the initial call. We conducted a systematic review to quantify the accuracy of emergency dispatcher stroke recognition when employing stroke screening tools.
Methods: We conducted a comprehensive search Medline, EMBASE, CINAHL, and Cochrane databases to identify studies of dispatcher stroke recognition accuracy using a stroke screening tools such as the Medical Priority Dispatch System (MDPS) or Face Arm Speech Time (FAST) mnemonic. Studies were included if they reported dispatcher sensitivity or positive predictive value (PVP) using hospital stroke/TIA diagnosis as the gold standard. Study quality was assessed using QUADAS 2. Two independent reviewers determined study eligibility, assessed quality, and abstracted data.
Results: We identified 1450 abstracts; seven cohort studies met inclusion criteria. Stroke screening tools included MPDS (n=4), FAST (n=2), and a novel screening algorithm (n=1). The sensitivity of dispatcher stroke recognition (5 studies, range 41-83%) and PPV (7 studies, range 42% -68%) were variable. Specificity was high (3 studies, 95-99%). No screening tool demonstrated superiority. Included studies had moderate risk of bias and dramatically variable stroke prevalence (range 3-68%).
Conclusion: Published reports of screening tools utilized by emergency dispatchers demonstrate suboptimal sensitivity and PPV. More research is needed to identify the causes of poor dispatcher stroke recognition and to improve stroke screening tools.