Simulated Patients to Demonstrate Common Stroke Syndromes: Accurate and Convincing

Area of Science:

• Neurology
• Medical Education
• Emergency Medical Services

Background:

• Preclinical stroke detection is challenging, with over a third of strokes missed by EMS personnel.
• Prehospital identification of anterior large vessel occlusion (LVO) stroke is a growing focus.
• Cortical signs, crucial for LVO stroke detection, are frequently missed by EMS.

Purpose of the Study:

• To assess if simulated patients (SPs) can convincingly simulate stroke syndromes and symptoms.
• To determine if stroke experts can reliably identify simulated stroke syndromes using the NIH Stroke Scale (NIHSS).

Main Methods:

• Lay actors were trained to simulate 8 distinct stroke syndromes (lacunar or anterior LVO).
• Actors were videotaped during NIHSS examinations.
• Stroke experts rated the videos for syndrome identification, NIHSS score accuracy, and simulation quality.

Main Results:

• Seven out of eight simulated stroke syndromes were correctly identified by a majority of expert raters.
• The mean NIHSS score ratings were within one point of the target scores for six out of eight syndromes.
• The quality of simulation was rated highly, between 3.54 and 3.98 on a 4-point scale.

Conclusions:

• Simulated patients can accurately and convincingly portray acute stroke symptoms and syndromes.
• SPs are a valuable resource for enhancing educational interventions aimed at improving stroke recognition.
• This study supports the use of SPs in training EMS personnel for better stroke detection.