Kim 2017.

Study characteristics
Patient sampling	Study conducted in Busan, Republic of Korea Sampling: people with suspected stroke transported to a single hospital by EMS paramedics and people with true stroke without stroke recognition by EMS for 12 months; data extracted from emergency care records including CPSS documented by EMS paramedics and hospital medical records.
Patient characteristics and setting	Inclusion and exclusion criteria: people with suspected stroke referred by paramedics and people with true stroke admitted during the same period (no further details). Participant characteristics: not reported
Index tests	Index test: CPSS Test administrator: paramedics Training: not reported
Target condition and reference standard(s)	Target condition: stroke/TIA Reference standard: hospital medical records (no further details)
Flow and timing	268 people with suspected stroke referred, of whom 152 had confirmed stroke/TIA; time between CPSS and final diagnosis not reported.
Comparative
Diagnostic test accuracy data	Prevalence: 152/268 (56.7%) participants had stroke/TIA CPSS: TP = 142, FP = 31, FN = 10, TN = 85
Notes	Proportion of stroke/TIA: stroke = 149, TIA = 3 Alternative diagnoses: not reported Additional information: people with ischemic stroke with stroke recognition by EMS using CPSS had a higher NIHSS score (10 with CPSS vs 6 with negative or no documented CPSS; P = 0.001) and shorter on‐scene to door time (22 with CPSS vs 25 minutes with negative or no documented CPSS; P = 0.009) and were more likely to be treated with tissue plasminogen activator (49.7% with CPSS vs 32.2% with negative or no documented CPSS; P = 0.007) than these with negative or no documented CPSS.
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?	Unclear
Prospective design	No
		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?	Unclear
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?	Unclear
Were all patients included in the analysis?	Unclear
Did all patients receive a reference standard?	Unclear
		Unclear