Fothergill 2013.

Study characteristics
Patient sampling	Royal London Hospital, UK Sampling: prospective but not consecutive as only people assessed with ROSIER and conveyed to the Royal London Hospital were included (32 people did not receive ROSIER and were not included in the study).
Patient characteristics and setting	Inclusion criteria: ages > 18 years presenting with symptoms of stroke Exclusion criteria: ages < 18 years, not assessed using the ROSIER or transferred to another hospital Participant characteristics: mean age 65 years, range 20–95 years; 53% men; people with seizure history included
Index tests	Index test: FAST, ROSIER Test administrator: paramedics Training: 1‐hour stroke educational program, scenario‐based demonstration of ROSIER, 15‐minute educational DVD
Target condition and reference standard(s)	Target condition: stroke/TIA Reference standard: final diagnosis made by a stroke consultant or other senior medical physician caring for the person within 72 hours of the person's admission to hospital. Routine tests used, including CT and MRI scans, undertaken by the clinical team to confirm whether the person had a stroke. Final diagnosis was confirmed by a senior stroke consultant.
Flow and timing	32 people not assessed by index tests; 17 without reference standard results.
Comparative
Diagnostic test accuracy data	Prevalence of stroke/TIA: 177/295 (60%) ROSIER: TP = 171; FP = 97; FN = 6; TN = 21 FAST: TP = 171; FP = 103; FN = 6; TN = 15
Notes	Categorization of alternate diagnosis for participants who did not have an ischemic stroke: not reported Funding: not reported
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	No
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	No
Prospective design	Yes
		High	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?	Unclear
		Unclear	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