Abstract
BackgroundThe present study aims to evaluate the performance and the clinical applicability of the Recognition of Stroke in the Emergency Department (ROSIER) scale via systematic review and meta-analysis.MethodsElectronic databases of Pubmed and Embase were searched between 1st January 2005 (when ROSIER developed) and 8th May 2020. Studies that evaluated the diagnostic accuracy of the ROSIER scale were included. The sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were combined using a bivariate mixed-effects model. Fagan nomogram was used to evaluate the clinical applicability of the ROSIER scale.ResultsA total of 14 studies incorporating 15 datasets were included in this meta-analysis. The combined sensitivity, specificity, DOR and AUC were 0.88 [95% confidence interval (CI): 0.83–0.91], 0.66 (95% CI: 0.52–0.77), 13.86 (95% CI, 7.67–25.07) and 0.88 (95% CI, 0.85–0.90), respectively. Given the pre-test probability of 60.0%, Fagan nomogram suggested the post-test probability was increased to 79% when the ROSIER was positive. In comparison, it was decreased to 22% when ROSIER was negative. Subgroup analysis showed that the pooled sensitivity of ROSIER in the European population was higher than that in Asia. In contrast, the pooled specificity was not significantly different between them. Moreover, results also suggested the male-to-female ratio ≤ 1.0 subgroup, prehospital setting subgroup, and other trained medical personnel subgroup had significantly higher sensitivity compared with their counterparts. At the same time, no significant differences were found in the pooled specificity between them.ConclusionsROSIER is a valid scale with high clinical applicability, which has not only good diagnostic accuracy in Europe but also shows excellent performance in Asia. Moreover, the ROSIER scale exhibits good applicability in prehospital settings with other trained medical personnel.
Highlights
The present study aims to evaluate the performance and the clinical applicability of the Recognition of Stroke in the Emergency Department (ROSIER) scale via systematic review and meta-analysis
Data abstraction Characteristics of the first author, publication year, geographic background, study design, work setting, ROSIER assessment investigator, study period, sample size, mean age or rang of age, true positive (TP), false positive (FP), false negative (FN), and TN were independently extracted by two investigators
159 publications were excluded: 64 were duplicated, 113 were not related, 47 were reviews, 18 were conference abstract, 10 were case report, one did not use a cutoff value of four [35] and Diagnostic accuracy of the ROSIER The pooled sensitivity, specificity, diagnostic odds ratio (DOR) and area under the curve (AUC) were 0.88, 0.66, 13.86 and 0.88, respectively. (Fig. 2 a-b) Substantial heterogeneity existed in the pooled sensitivity (I2 = 91.25%, p < 0.001), pooled specificity (I2 = 97.33%, p < 0.001), and the pooled DOR (I2 = 100.00%, p < 0.001)
Summary
The present study aims to evaluate the performance and the clinical applicability of the Recognition of Stroke in the Emergency Department (ROSIER) scale via systematic review and meta-analysis. Previous studies have systematically evaluated its performance [18,19,20,21], the clinical utility and the applicability in other countries, and investigators have not been investigated before. Another seven studies have not been incorporated in previous meta-analyses [22,23,24,25,26,27,28]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
