Andsberg 2017.

Study characteristics
Patient sampling	Pilot study conducted in an ambulance district staffed by 43 ambulance nurses for 24‐hour service for the community hospital of Hässleholm, Sweden. Sampling: during the study period (9 January to 23 May 2014) neurologic assessment with PreHAST was done if stroke was suspected in conscious people > 18 years of age.
Patient characteristics and setting	Inclusion and exclusion criteria: neurologic assessment with PreHAST was done if stroke was suspected, defined as sudden onset of focal neurologic symptoms/signs, in conscious people > 18 years of age. Participant characteristics: not reported
Index tests	Index test: PreHAST (score > 0 considered positive) Test administrator: ambulance nurses Training: before the study period all ambulance nurses received a 4‐hour education program, covering basic stroke knowledge and assessment and grading of stroke symptoms according to PreHAST. The education program included practical PreHAST training in pairs, where each ambulance nurse performed the PreHAST items under supervision and proper execution. During the study an instruction video for PreHAST was available on YouTube.
Target condition and reference standard(s)	Target condition: stroke/TIA (people with TIA included in the study were required to have ongoing symptoms when evaluated by the ambulance staff; used time‐based definition of TIA). Reference standard: 2 stroke physicians, blinded to the PreHAST scores, independently reviewed the medical records of the participants, including evaluation of history, and clinical and radiologic findings. In case of disagreement, a third evaluator adjudicated the final diagnosis.
Flow and timing	78 participants were assessed with PreHAST; 9 were excluded (5 informed consent not obtained; 2 PreHAST was not possible to perform due to agitation and ongoing epileptic seizure; 2 did not have symptoms at ambulance arrival).
Comparative
Diagnostic test accuracy data	Prevalence of stroke/TIA: 26/69 (37.7%) participants had stroke/TIA PreHAST: TP = 26, FP = 26, FN = 0, TN = 17
Notes	Non‐stroke diagnoses: 8 epilepsy, 7 late effect after stroke, 5 migraine, 3 Bell's palsy, 3 fatigue, 1 SDH, 1 dementia, 5 vertigo, 3 syncope, 2 infection, 2 delirium, 1 transitory global amnesia, 1 opsoclonus syndrome Ease of use and time: in the poststudy survey, the ambulance staff reported PreHAST easy to execute and estimated the test time to be 2–3 minutes. Funding: financed by departmental funds
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Yes
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Yes
Prospective design	Yes
		Low	Low
DOMAIN 2: Index Test Index tests
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
If a threshold was used, was it pre‐specified?	Yes
		Low	Low
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Yes
		Low	Low
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Yes
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	Yes
Did all patients receive a reference standard?	Yes
		Low