Background and Purpose: Stroke is the fifth leading cause of death in the United States. It is projected by the year 2030, there will be a 20.5% increase in the prevalence of stroke, with women being at highest risk. Women can present with nontraditional symptoms of stroke. The purpose of this review of literature was to determine the accuracy, reliability, validity, and sensitivity of existing stroke screening tools that incorporate nontraditional symptoms, and examine gender differences.
Methods: A systematic review of peer-reviewed literature was completed in five databases: CINAHL Google Scholar, ProQuest, PubMed, and SCOPUS. Websites were scanned for gray material. Key terms where utilized as text words, title, abstract and medical subject headings to identify related studies of relevance.
Results: References were screened by title and abstract. Twenty-nine out of 1175 articles met the inclusion criteria. Seven stroke screening tools were identified; Melbourne Ambulance Stroke Screen, Los Angeles Prehospital Stroke Screen (LAPSS), Cincinnati Prehospital Stroke Scale, Ontario Prehospital Stroke Screening Tool, Medic Prehospital Assessment for Code Stroke, the Recognition of Stroke in the Emergency Room, and Face Arm Speech Test. A thematic synthesis approach organizing data according to patterns identified: early recognition of stroke is crucial to timely treatment and better patient outcomes, a difference in stroke symptoms exists between genders, knowledge and awareness of nontraditional stroke symptoms are essential for early identification, current stroke screen tools have a potential for nearly 30% error of non-identification of stroke, and only 2 of 7 screening tools identify more than 1 of 11 non-traditional symptoms with the most encouraging tool (LAPSS) only identifying 3 symptoms (loss of consciousness, confusion, and seizures).
Conclusions: Evidence suggests limitations exists within current stroke screens. Poor recognition of nontraditional symptoms due to lack of stroke screening tools may delay treatment and worsen patient outcomes. Research is required to identify variables and develop a stroke screening tool that is sensitive and specific to nontraditional stroke symptoms in women.