Jiang 2014.

Study characteristics
Patient sampling	Prince of Wales hospital, Chinese University of Hong Kong; 1 June 2011 to 31 December 2011 Sampling: prospective cohort, consecutive participants presenting to ER
Patient characteristics and setting	Inclusion and exclusion criteria: Inclusion: > 18 years old, presenting to ER with symptoms/signs suggestive of stroke/TIA Exclusion: trauma brain injury with an external cause, incomplete medical records, direct admission to ward, SAH, SDH, TIA without symptoms/signs during the assessment Participant characteristics: mean age in stroke/TIA group 72 (SD 13) years, mean age in stroke mimics group 69 (SD 14) years; 53.4% men; seizure history: 11 people with seizure history; 295/715 (41%) participants had an onset time > 24 hours prior to assessment, hence the high concerns regarding the applicability of results.
Index tests	Index test: ROSIER Test administrator: specialist stroke nurses or consultant in emergency medicine Training: research staff received the specific training by stroke nurse and by a test provided by the NIHSS website. All the criteria for the scale followed the rules of the NIHSS.
Target condition and reference standard(s)	Target condition: stroke/TIA Reference standard: stroke defined as a focal or global neurologic deficit with symptoms lasting for 24 hours, or resulting in death within 24 hours, which after investigation was thought to be due to a vascular cause; TIAs were defined as clinical syndromes characterized by an acute loss of focal cerebral or monocular function with symptoms lasting < 24 hours and thought to be caused by inadequate blood supply as a result of thrombosis or embolism. All people suspected of stroke were reviewed by the stroke team which included 4 stroke nurses and 2 specialist doctors. The final diagnoses were made after their assessment and after review of clinical symptoms and the acute neuroimaging (CT and MRI), and this was used as the reference standard for diagnosis in the study.
Flow and timing	Cases excluded from analysis: 51 in total of which: 4 incomplete records, 2 not accessible, 45 did not meet original ROSIER scale criteria (people with SAH, SDH, TIA). Time interval between the use of the scales and the final diagnosis, mean: 4.96 (SD 0.23) days.
Comparative
Diagnostic test accuracy data	Prevalence of stroke/TIA: 371/715 (52%) ROSIER: TP = 323; FP = 202; FN = 48; TN = 142
Notes	Categorization of alternate diagnosis for participants who did not have an ischemic stroke: 34 spinal neuropathy, 27 dementia, 27 labyrinthitis, 27 sepsis, 24 musculoskeletal, 24 syncope, 21 hypertension, 20 somatization, 18 metabolic, 17 uncertain, 16 brain tumor, 16 peripheral neuropathy, 14 encephalopathy, 14 numbness, 13 TGA Additional outcomes: provided by the authors Funding: Direct Grant for research of the Chinese University of Hong Kong
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	High
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?	Unclear
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
		Unclear