Mingfeng 2017.

Study characteristics
Patient sampling	Luocun Community Health Service Center (LCHSC) of Nanhai District affiliated with the Nanhai Hi‐Tech Industrial Zone Hospital (NHIZH) of Foshan, a Level‐II hospital with the capability of managing acute stroke, and Zhangcha Community Health Service Center (ZCHSC) of Chancheng District, Foshan City, affiliated with the Foshan Hospital of Traditional Chinese Medicine (FSTCM), a tertiary care teaching hospital with acute stroke center, China Sampling: all people presenting to the 2 health centers; August 2012 to January 2016; ages > 18 years with suspected stroke or TIA and with symptoms or signs observed by GPs in LCHSC and ZCHSC were included in this study.
Patient characteristics and setting	Inclusion criteria: suspected stroke or TIA based on the following clinical signs: numbness or weakness in the face, arms or legs (especially on 1 side of the body); confusion, difficulty in speaking or understanding speech; vision disturbance in 1 or both eyes; dizziness, walking difficulties, loss of balance or co‐ordination; severe headache without known cause Exclusion criteria: head trauma or surgery in recent months; previous stroke with neurologic deficits; incomplete medical testing was excluded from this study Participant characteristics: mean age 67.54 (SD 12.66) years; 192 (41.03%) women
Index tests	Index test: ROSIER, CPSS Test administrator: 16 GPs Training: GPs were trained by emergency physicians on the use of the ROSIER scale and CPSS for 10 hours before the study
Target condition and reference standard(s)	Target condition: stroke/TIA (only people with observed symptoms/signs by the GPs were included) Reference standard: final discharge diagnosis of stroke or TIA made by neurologists reviewing all diagnostic information including CT scan of the brain (immediately after transfer), blood tests and 12‐lead ECG conducted in the ER; comprehensive neurologic assessment including additional tests, such as continuous ECG monitoring, 24‐hour Holter ECG, duplex carotid and cardiac ultrasound, TCD, MRI or MRA, and conventional cerebral angiography were performed as requested by the neurologists once the participant was transferred to the neurology ward. The neurologists who made the final diagnosis were blinded to the results from the ROSIER and CPSS.
Flow and timing	512 people with suspected stroke assessed by GPs, of whom 468 met the study inclusion criteria; the CT scan of the brain was done immediately after the participant was transferred to the ER.
Comparative
Diagnostic test accuracy data	Prevalence of stroke/TIA: 332/468 (70.94%) participants had final diagnosis stroke or TIA; 240 (72.29%) of the participants had ischemic stroke/TIA and 92 (27.71%) hemorrhagic stroke ROSIER: TP = 276, FP = 26, FN = 56, TN = 110 CPSS: TP = 259, FP = 40, FN = 73, TN = 96
Notes	Stroke mimics: 136 participants (45 syncope, 28 seizure, 26 vertigo, 10 hypoglycemia, 8 hypokalemia, 5 sepsis, 4 brain tumor, 3 hysteria, 2 alcohol intoxication, 2 hepatic encephalopathy, 2 Meniere's syndrome and 1 demyelination) Funding: funding provided by the Internal Grants from Science and Technology Foundation of Foshan City, China (no. 2014AB00328, no. 2014AG10002, and no. 2015AB00354), Guangdong Province Science and Technology Foundation (no. 2014A020212002) and the Municipal Clinical Key Specialty Construction Project Funds of Foshan City (no. Fspy2‐2015004 and no. FSGSSPZD135025).
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