Betül AKBUĞA ÖZEL
Ankara Medical Journal - 2026;26(1):111-127
Objectives: Prehospital delay in acute ischemic stroke is driven by decision delay between symptom recognition and taking action. Although witnesses recognise symptoms early, the value of translating witness-reported symptoms into standardised stroke assessment tools remains unclear. This study aimed to evaluate the predictive value of witness-derived, physician-administered secondary Cincinnati Prehospital Stroke Scale (CPSS) scores. Materials and Methods: This prospective, cross-sectional validation study was conducted in a tertiary ED between August and November 2025. Secondary CPSS scores were independently assigned by two blinded emergency physicians using the three-item CPSS, based on structured interviews with untrained witnesses of stroke-like patients. Predictive validity was assessed using final ED diagnoses, and decision delay was derived from standardised prehospital timelines. Statistical analyses included Cohen's kappa, diagnostic accuracy metrics, and chi-square tests. Results: A total of 235 patient-witness pairs were included. More than 70% of witnesses delayed action for over 30 minutes, accounting for 56.3% of prehospital delay. Interrater reliability was substantial (kappa = 0.788). Secondary CPSS scores showed low sensitivity and negative predictive value but high specificity and positive predictive value, indicating limited rule-in utility. Scores >=1 were not associated with shorter decision delay (p = 0.789). Conclusion: Secondary CPSS based on witness reports is reliably scored but has limited diagnostic accuracy and does not facilitate faster decision-making, limiting its utility as a standalone tool for prehospital stroke triage. Future studies should address cognitive barriers and improve witness response.
