OBJECTIVE: To identify and compare the operating characteristics of existing 
prehospital stroke scales to predict true strokes in the hospital.
METHODS: We searched MEDLINE, EMBASE, and CINAHL databases for articles that 
evaluated the performance of prehospital stroke scales. Quality of the included 
studies was assessed using the Quality Assessment of Diagnostic Accuracy 
Studies-2 tool. We abstracted the operating characteristics of published 
prehospital stroke scales and compared them statistically and graphically.
RESULTS: We retrieved 254 articles from MEDLINE, 66 articles from EMBASE, and 32 
articles from CINAHL Plus database. Of these, 8 studies met all our inclusion 
criteria, and they studied Cincinnati Pre-Hospital Stroke Scale (CPSS), Los 
Angeles Pre-Hospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Screen 
(MASS), Medic Prehospital Assessment for Code Stroke (Med PACS), Ontario 
Prehospital Stroke Screening Tool (OPSS), Recognition of Stroke in the Emergency 
Room (ROSIER), and Face Arm Speech Test (FAST). Although the point estimates for 
LAPSS accuracy were better than CPSS, they had overlapping confidence intervals 
on the symmetric summary receiver operating characteristic curve. OPSS performed 
similar to LAPSS whereas MASS, Med PACS, ROSIER, and FAST had less favorable 
overall operating characteristics.
CONCLUSIONS: Prehospital stroke scales varied in their accuracy and missed up to 
30% of acute strokes in the field. Inconsistencies in performance may be due to 
sample size disparity, variability in stroke scale training, and divergent 
provider educational standards. Although LAPSS performed more consistently, 
visual comparison of graphical analysis revealed that LAPSS and CPSS had similar 
diagnostic capabilities.