Introduction Stroke detection in the preclinical setting is challenging, resulting in more than 1/3 of missed strokes by EMS personnel. Recently, prehospital identification of anterior large vessel occlusion (LVO) stroke has come into focus. Cortical signs have a high predictive value for the presence of LVO stroke but are often missed. Simulated patients (SPs) could be an excellent tool to train EMS personnel in the evaluation of stroke syndromes with cortical symptoms but it has not been studied whether they can simulate these important signs convincingly. The main objective of this study was thus to examine whether SPs can simulate stroke syndromes and symptoms so that stroke experts can identify them correctly and reliably, applying the NIH stroke scale (NIHSS). Methods Lay actors were trained to simulate one of 8 stroke syndromes either typical of a lacunary stroke or of an anterior LVO stroke and then videotaped during an examination according to the NIHSS. Stroke experts were asked to rate each item of the NIHSS based on the videos, determine which stroke syndrome was being demonstrated, and rate the quality of the simulation. The primary outcome was the correct identification of the target stroke syndrome by the expert raters. Secondary outcomes were the agreement of the rating of the NIHSS score with the target NIHSS score and the expert raters' assessment of the quality of the simulation. Results Seven of eight syndromes were rated correctly by at least twelve of fifteen raters and the mean rated NIHSS score was within one point of the target score for six of eight syndromes. The mean rating for the quality of simulation was between 3.54 and 3.98 (as rated on a scale from 1 to 4) for each syndrome. Discussion/Conclusion SPs are capable of simulating acute stroke symptoms and syndromes accurately and convincingly. They thus represent a great resource to improve educational interventions that improve stroke recognition.

中文翻译：

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模拟患者展示常见的中风综合症：准确且令人信服。

简介 临床前环境中的中风检测具有挑战性，导致 EMS 人员漏诊了超过 1/3 的中风。最近，前大血管闭塞（LVO）卒中的院前识别已成为焦点。皮质体征对 LVO 卒中的存在具有很高的预测价值，但经常被忽视。模拟患者（SP）可能是培训 EMS 人员评估伴有皮质症状的中风综合征的绝佳工具，但尚未研究它们是否能够令人信服地模拟这些重要体征。因此，本研究的主要目的是检验 SP 是否可以模拟中风综合症和症状，以便中风专家能够应用 NIH 中风量表 (NIHSS) 正确可靠地识别它们。方法 训练非专业演员模拟 8 种中风综合症中的一种，要么是典型的腔隙性中风，要么是左心室前部中风，然后根据 NIHSS 在检查过程中进行录像。中风专家被要求根据视频对 NIHSS 的每个项目进行评分，确定正在演示的是哪种中风综合症，并对模拟的质量进行评分。主要结果是专家评估者正确识别目标中风综合征。次要结果是 NIHSS 评分与目标 NIHSS 评分的一致性以及专家评分者对模拟质量的评估。结果 8 种综合征中的 7 种被 15 名评估者中的至少 12 名正确评估，并且 8 种综合征中有 6 种的 NIHSS 平均评分与目标分数相差不到 1 分。每种综合征的模拟质量平均评分在 3.54 到 3.98 之间（按 1 到 4 的等级评分）。讨论/结论 SP 能够准确且令人信服地模拟急性中风症状和综合征。因此，它们是改善教育干预措施以提高中风识别的重要资源。