Clinical Practice Guideline for the Prehospital Stage in Acute Stroke : I. Use of Emergency Medical Services Assessment Tools
- Author:
Jae Sang OH
1
;
Dongwook SEO
;
Jinwoo JEONG
;
Kyoung-Chul CHA
;
Yong Soo CHO
;
Su Jin KIM
;
Jongkyu PARK
;
Won-Sang CHO
;
Se Won OH
;
Jang Hun KIM
;
Hyeong Jin LEE
;
Hong Suk AHN
;
Yuna JO
;
Jung-Jae KIM
;
Kyoung Min JANG
;
Gi-Yong YUN
;
Jong Min LEE
;
Hoon KIM
;
Young Woo KIM
;
Tae Gon KIM
;
Sung-kon HA
;
Sukh Que PARK
;
Soon Chan KWON
Author Information
- Publication Type:Review Article
- From:Journal of Korean Neurosurgical Society 2026;69(1):7-22
- CountryRepublic of Korea
- Language:English
- Abstract: Accurate and early identification of stroke and large vessel occlusion (LVO) in emergency settings is essential for improving patient outcomes and ensuring the efficient allocation of medical resources. This clinical practice guideline systematically reviews domestic and international literature and conducts meta-analyses to evaluate the utility and diagnostic accuracy of stroke assessment tools used in prehospital emergency medical services (EMS). We developed a guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted to evaluate the usefulness of diagnostic EMS assessment tools for diagnosing stroke and LVO. Overall, 70 non-randomized control studies were selected for this study. A meta-analysis was conducted with a subgroup analysis to distinguish between patients with stroke and those with LVO. EMS tools demonstrated high sensitivity but low specificity for diagnosing stroke. In the prehospital setting, using validated EMS stroke assessment tools is recommended for the early identification of stroke and LVO. Upon hospital arrival, stroke specialists should conduct further evaluation and triage to confirm the diagnosis and guide appropriate management. Delays in diagnosing LVO are frequently unacceptable. While experts advocate for the use of EMS assessment tools to facilitate early identification of LVO, these tools alone lack adequate sensitivity. Therefore, further diagnostic evaluations and consultation with stroke specialists upon hospital arrival are recommended.
