Study	Reason for exclusion
Alhanati 2014	No stroke scale specified.
Asimos 2014	Did not meet gold standard of diagnosis of stroke/diagnosis not confirmed by stroke physician, just used ICD 9/10 codes.
Belvis 2005	No stroke scale specified.
Benjamin 2013	Diagnosis not confirmed by neurologist.
Birnbaum 2008	Not a scale specific to stroke/inappropriate scale.
Blomberg 2014	No stroke scale specified.
Bray 2005b	Did not meet reference standard, author contacted requesting more information, did not receive adequate response.
Brott 1989	Inappropriate scale.
Buck 2009	Study of dispatchers, no stroke scale specified.
Caceres 2013	No stroke scale specified.
Camerlingo 2002	Questionnaire over the telephone, no stroke scale specified.
Casolla 2013	No stroke scale specified.
De La Ossa 2014	Scale only assessed large artery occlusions.
Deakin 2009	Test administered by dispatcher.
Demeestere 2017	Evaluation of NIHSS‐8 for LVO using retrospectively derived scores.
Ellison 2004	No stroke scale specified.
Ferri 2005	Study protocol.
Ferro 1996	No stroke scale specified.
Ferro 1998	No stroke scale specified.
Fischer 2008	No stroke scale specified.
Garnett 2010	Protocol only, no scale.
Garrett 2013	Prognosis scale for ICH.
Govindarajan 2011	Protocol only.
Govindarajan 2012	Dispatchers only.
Gropen 2018	New stroke scale, EMSA, combining stroke recognition and severity assessment; paper described derivation and internal validation using patient records (inappropriate design).
Grossman 2011	Inappropriate scale.
Hand 2006	Not a prehospital stroke scale, scale administered by research fellow, neurologists and internists.
Harbison 2003	Did not meet reference standard.
Hasegawa 2013	Did not meet reference standard.
Henry‐Morrow 2017	Evaluation of educational intervention for prehospital recognition of stroke (not an evaluation of a stroke scale).
Herzberg 2014	Use of prehospital TCD, no stroke scale specified.
Heuer 2012	Did not evaluate stroke scale (evaluation of diagnostic accuracy of ER physicians).
Huang 1994	Allen score in clinical diagnosis of intracranial hemorrhage.
Hurwitz 2005	Test administered by lay telephone caller.
Iguchi 2011	Evaluation of the Kurashiki prehospital severity scale in identifying thrombolytic candidates.
Jang 2014	Evaluation of the Kurashiki prehospital severity scale in identifying thrombolytic candidates.
Jia 2017	Accuracy of EMS diagnosis of stroke, no specific scale evaluated; retrospective data used.
Josephson 2008	ABCD score calculated post‐hoc.
Kidwell 1998	Scale tested retrospectively.
Kimura 2008	Scale of severity.
Kothari 1995	No stroke scale specified.
Kothari 1997	Creation of a new stroke scale from NIHSS.
Kothari 1999	Scale done postadmission, after diagnosis have been made.
Krebes 2012	Evaluation of dispatcher's use.
Kwiatkowski 2006	Comment on another study.
Lange 2011	Only analyzed results of people who would be eligible for tPA, do not report data regarding accuracy of stroke scale.
Lavin 2014	Electronic triaging tool for family doctors.
Levine 2016	Review paper (not primary study).
Liferidge 2004	CPSS used by layperson.
Lin 2012	Prenotification study.
Llanes 2004	Scale of severity.
Malekzadeh 2015	CPSS used by dispatch nurses.
Mao 2016	Recruited people with suspected stroke presenting to the ER with symptoms or signs within 7 days.
Middleton 2016	Study protocol, general ER triage scale, not specific to stroke.
Mohd 2004	Only FAST‐positive cases, focus on agreement between paramedics and physicians.
Mosley 2013	No stroke scale specified.
Nam 2014	Description of smart phone app, not accuracy study.
Nazliel 2008	Measure of stroke severity, indication of LVO.
Newman‐Toker 2013	Only included people with vertigo/dizziness.
Noorian 2016	Stroke severity scale, target condition LVO.
Nor 2004	Objective of the study was an agreement between paramedics on the scene and by stroke physicians after admission in determining acute stroke signs using FAST. Analysis was confined to acute stroke cases; only FAST‐positive participants identified as suspected stroke by paramedics were included. Nor 2005 reported on the same cohort of participants.
O'Brien 2012	Analysis of prehospital protocol, do not examine accuracy of FAST.
Ollikainen 2018	New stroke scale, FPSS, which combines stroke recognition and LVO identification. Study reported development and validation of scale using patient records (inappropriate design).
Oostema 2015	Focus on EMS accuracy to recognize stroke, not the accuracy of CPSS; also conference abstract, no full text.
Oostema 2016	Systematic review of the accuracy of emergency dispatchers stroke recognition when employing stroke screening tools.
Perez de la Ossa 2014	Predictor for LVO.
Purrucker 2015	Scales determined retrospectively from NIHSS; data collected from the ER neurological report.
Purrucker 2017	Reports the development of "an NIH Stroke Scale (NIHSS) compatible, all‐in‐one scale for rapid and comprehensive prehospital stroke assessment including stroke recognition, severity grading and progression monitoring as well as prediction of large vessel occlusion (LVO)." Validation using patient records (same cohort as in Purrucker 2015) (inappropriate design).
Quenardelle 2016	FAST calculated a posteriori, data collection to produce a FAST score not described in detail but very likely derived from the neurologist's initial assessment.
Qureshi 2016	Stroke severity scales evaluated; target condition LVO.
Richards 2016	Evaluated dichotomized CPSS to recognize people suitable for revascularization.
Robinson 2013	Public knowledge study.
Rodriguez‐Pardo 2017	Evaluation of new criteria to identify people eligible for mechanical thrombectomy.
Ross 2007	Protocol for workup of TIA.
Rudd 2015	Review paper of Rudd 2016.
Rudd 2016	Systematic review.
Schilling 2012	No stroke scale specified.
Schrock 2009	ABCD score as a predictor of positive work up for TIA.
Sequeira 2015	Retrospective analysis of the accuracy of several scales but the reference standard was the NIHSS; conference abstract, no full data.
Shapiro 2003	Evaluation of electronic stroke tool, not a purely diagnostic scale, no outcomes reported for accuracy.
Sheppard 2015	Not a diagnostic accuracy study; only people with established stroke diagnosis included.
Silva 2015	End‐to‐end study of the impact of LAPSS results upon clinical outcome (mRS < 3) at discharge; conference abstract, no diagnostic accuracy data reported.
Smith 1998	No stroke scale specified.
Smith 1999	No stroke scale specified.
Soda 2016	"4iss" scale; probably a combined recognition/severity tool but only abstract available; "4iss" was used in people who had a positive score on FAST, as decided by paramedics.
Timerding 1989	No stroke scale specified.
Tirschwell 2002	NIHSS performed by a neurologist.
Tonomura 2015	Investigated the clinical characteristics of pseudonegative cases in prehospital triage for stroke/TIA by EMS; only people with established stroke diagnosis included; conference abstract.
Trivedi 2015	End‐to‐end retrospective analysis of a statewide database; only conference abstract with no sufficient test accuracy data to recreate 2 × 2 table; authors did not reply to data request.
Turc 2016	Target condition LVO.
Van Hooff 2013	Telemedicine, simulation.
Verma 2010	No stroke scale specified.
Wennman 2012	No stroke scale specified.
Wesley 2016	Comment, no primary study.
Williams 2015	FAST score obtained retrospectively, evaluates accuracy of paramedics' decision, not the instrument.
Williams 2017	Evaluation of paramedics' accuracy, not FAST (FAST was recorded only in half of the cases); ER discharge diagnosis (not hospital) was used as a reference standard (inappropriate intervention and reference standard).
Wojner‐Alexandrov 2005	Evaluates accuracy of paramedics' decision, not the instrument; all EMS runs rather than those with neurologically relevant symptoms used to calculate false‐negative rate.
Yamashita 2011	Inappropriate scale; attempts to differentiate hemorrhage from ischemic stroke.
Yilmaz 2014	Inappropriate reference standard, MRI only.
Yock‐Corrales 2011	Participants were children.
You 2013	CPSS as a predictor of thrombolysis.
Zamora 2013	Awareness of scales in a population of medical doctors.
Ziegler 2008	No reference standard mentioned; unable to obtain additional information from authors.
Zohrevandi 2015	Retrospective analysis based on ER records.

ABCD: age, blood pressure, clinical features, duration of TIA, and presence of diabetes; CPSS: Cincinnati Prehospital Stroke Scale; ER: emergency room; EMS: emergency medical service; EMSA: Emergency Medical Stroke Assessment; FAST: Face Arm Speech Time; ICD: International Classification of Disease; ICH: intracerebral hemorrhage; LAPSS: Los Angeles Prehospital Stroke Scale; LVO: large vessel occlusion; MRI: magnetic resonance imaging; mRS: modified Rankin Scale; NIHSS: National Institutes of Health Stroke Scale; TCD: transcranial Doppler; TIA: transient ischemic attack; tPA: tissue plasminogen activator.