Open Access Open Badges Study protocol

Comparative Evaluation of Stroke Triage Algorithms for Emergency Medical Dispatchers (MeDS): Prospective Cohort Study Protocol

Prasanthi Govindarajan1*, David Ghilarducci2, Charles McCulloch3, Jessica Pierog4, Evan Bloom1 and Claiborne Johnston5

Author Affiliations

1 Department of Emergency Medicine, 505 Parnassus Avenue L 126 Mail Code 0208, University of California San Francisco, San Francisco, CA 94143-0208, USA

2 American Medical Response EMS agency, 268 Calvin Place, Santa Cruz, CA 95060, USA

3 Division of Biostatistics, UCSF Box 0560, 185 Berry Street, Lobby 5, Suite 5700 San Francisco, CA 94107-1762, USA

4 Division of Emergency Medicine, 300 Pasteur Drive, Alway Bldg M121 Mail Code: 5119 Stanford, CA 94305-2200, USA

5 Departments of Neurology, Epidemiology and Biostatistics, University of California San Francisco, USA

For all author emails, please log on.

BMC Neurology 2011, 11:14  doi:10.1186/1471-2377-11-14

Published: 27 January 2011



Stroke is a major cause of death and leading cause of disability in the United States. To maximize a stroke patient's chances of receiving thrombolytic treatment for acute ischemic stroke, it is important to improve prehospital recognition of stroke. However, it is known from published reports that emergency medical dispatchers (EMDs) using Card 28 of the Medical Priority Dispatch System protocols recognize stroke poorly. Therefore, to improve EMD's recognition of stroke, the National Association of Emergency Medical Dispatchers recently designed a new diagnostic stroke tool (Cincinnati Stroke Scale -CSS) to be used with Card 28. The objective of this study is to determine whether the addition of CSS improves diagnostic accuracy of stroke triage.


This prospective experimental study will be conducted during a one-year period in the 911 call center of Santa Clara County, CA. We will include callers aged ≥ 18 years with a chief complaint suggestive of stroke and second party callers (by-stander or family who are in close proximity to the patient and can administer the tool) ≥ 18 years of age. Life threatening calls will be excluded from the study. Card 28 questions will be administered to subjects who meet study criteria. After completion of Card 28, CSS tool will be administered to all calls. EMDs will record their initial assessment of a cerebro-vascular accident (stroke) after completion of Card 28 and their final assessment after completion of CSS. These assessments will be compared with the hospital discharge diagnosis (ICD-9 codes) recorded in the Office of Statewide Health Planning and Development (OSHPD) database after linking the EMD database and OSHPD database using probabilistic linkage. The primary analysis will compare the sensitivity of the two stroke protocols using logistic regression and generalizing estimating equations to account for clustering by EMDs. To detect a 15% difference in sensitivity between the two groups with 80% power, we will enroll a total of 370 subjects in this trial.


A three week pilot study was performed which demonstrated the feasibility of implementation of the study protocol.