Predictive Value of Witness-derived Secondary Cincinnati Prehospital Stroke Scale Scores in Suspected Stroke

NCT07277790 | Completed

• 1 other identifier: TABED 1-25-1588
• Study Type: observational
• Target: 235
• Locations: 1 country
• Sites: 1

Brief Summary

The Cincinnati Prehospital Stroke Scale (CPSS) is traditionally scored directly by a healthcare professional or a layperson who independently observes facial droop, arm weakness, and speech disturbance, constituting the primary CPSS score. In contrast, this study focuses on witness-derived secondary CPSS scoring, which is performed indirectly by an emergency physician who is blinded to the patient's physical examination findings and relies exclusively on symptom descriptions provided by witnesses of the patient's initial presentation. This prospective analytical cross-sectional study aims to evaluate the predictive accuracy of secondary CPSS scores obtained by emergency physicians through structured interviews with witnesses of suspected stroke cases. Interrater reliability will be assessed between secondary CPSS scores independently assigned by a senior emergency medicine resident and an attending emergency physician based on witness-reported symptom descriptions. Secondary CPSS scores will then be compared with final neuroimaging diagnoses (CT/MRI), which will serve as the diagnostic gold standard. The study will also investigate the association between physician-coded secondary CPSS scores, witness demographic characteristics, and delays in seeking emergency medical care. Research Questions

1. 1.Are witness-derived secondary CPSS scores, as assigned by an emergency physician, a valid tool for predicting ischemic stroke?
2. 2.Are witness-derived secondary CPSS scores of ≥1 associated with shorter recognition-to-action time (decision delay)?
3. 3.Witness-derived secondary CPSS scores assigned by an emergency physician are a valid diagnostic tool for predicting ischemic stroke.
4. 4.Witness-derived secondary CPSS scores of ≥1 are associated with shorter recognition-to-action time.

Conditions

Stroke (CVA) or Transient Ischemic Attack

Keywords

Cincinnati Prehospital Stroke Scale; Witness-Derived CPSS; Stroke Witness; Decision Delay; Emergency Medicine; Predictive Validity

Outcome Measures

Primary Outcomes (2)

• Secondary CPSS Score

  Defined as the score indirectly derived from witness reports by an emergency physician who was blinded to the patient's physical examination and relied on the observations of individuals who witnessed the patient's initial symptoms. Physician-coded CPSS score derived from structured witness face-to-face interviews; assessed as a continuous variable (0-3) and dichotomized (≥1 vs 0).

  During ED admission interview

• Final Diagnosis

  Final diagnosis categorized as ischemic stroke, hemorrhagic stroke, or non-stroke, based on CT and/or MRI reports interpreted by independent radiologists.

  At completion of diagnostic evaluation (ED visit)

Secondary Outcomes (2)

• Decision Delay

  Reported by the witness at ED arrival

• Witness Demographic Characteristics

  Reported by the witness at ED arrival

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The study population was stroke witnesses (family members, friends, neighbors, or bystanders) who observed the patient's initial symptoms and accompanied the patient to the emergency department with acute suspected stroke symptoms.

You may qualify if:

• Age ≥18 years
• Witnessing onset/discovery of stroke-like symptoms
• Accompanying the patient to the ED
• Being the individual who decided to call EMS or arrange transport
• No cognitive impairment affecting communication
• Not a healthcare professional
• Patient requiring advanced neuroimaging (CT/MRI)
• Provided written informed consent

You may not qualify if:

• Age \<18 years
• Did not witness symptoms
• Cognitive impairment limiting communication
• Did not make the action decision
• Healthcare professionals
• Patients transferred with pre-confirmed stroke
• Lack of consent or withdrawal
• Missing/incomplete CPSS scoring items

Sponsors & Collaborators

• Ankara City Hospital Bilkent: lead

Study Sites (1)

Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara Bilkent City Hospital, Department of Emergency Medicine

Çankaya, Ankara, 06800, Turkey (Türkiye)

Location

Related Publications (2)

• De Luca A, Giorgi Rossi P, Villa GF; Stroke group Italian Society pre hospital emergency Services. The use of Cincinnati Prehospital Stroke Scale during telephone dispatch interview increases the accuracy in identifying stroke and transient ischemic attack symptoms. BMC Health Serv Res. 2013 Dec 11;13:513. doi: 10.1186/1472-6963-13-513.

  PMID: 24330761 RESULT

• Chiquete E, Sandoval-Rodriguez V, Garcia-Grimshaw M, Jimenez-Ruiz A, Gomez-Pina JJ, Ruiz-Ruiz E, Ramirez-Garcia G, Flores-Silva F, Cantu-Brito C, Ochoa-Guzman A, Ruiz-Sandoval JL. Reliability of Bystander Recognition of Clinical Features in Pre-Hospital Classification of Acute Cerebrovascular Syndromes: Preliminary Findings. Rev Invest Clin. 2020 May 7;73(2):87-93. doi: 10.24875/RIC.20000238.

  PMID: 33057320 RESULT

MeSH Terms

Conditions

Stroke; Ischemic Attack, Transient

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Brain Ischemia

Study Officials

• Betül Akbuğa Özel

  Ankara Bilkent City Hospital, Department of Emergency Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: November 29, 2025
• First Posted: December 11, 2025
• Study Start: August 15, 2025
• Primary Completion: November 15, 2025
• Study Completion: November 22, 2025
• Last Updated: December 19, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: After publication of the main results.
• Access Criteria: Academic researchers upon request to the corresponding author.

Locations

TU (1)