A systematic review including 14 studies with a total of 5,484 subjects was abstracted in DARE. The gold standard was evaluation by clinical expert who had reviewed all clinical data, neuro-imaging and other relevant laboratory tests. The authors assumed a 10% a prior probability of stroke The presence of acute facial paresis, arm drift or abnormal speech (as evaluated by physician assessment) increased the likelihood of stroke (LR of at least one finding 5.5, 95% CI: 3.3 to 9.1). The absence of all three symptoms decreased the odds of a stroke (LR of zero findings 0.39, 95% CI: 0.25 to 0.61). The early mortality from stroke was increased with the presence of impaired consciousness, hemiplegia or conjugate gaze palsy (LR of at least one finding 1.8, 95% CI: 1.2 to 2.8). The absence of all three symptoms decreased the odds of mortality (LR of zero findings 0.36, 95% CI: 0.13 to 1.0).
Comment: The quality of evidence is downgraded by the limited search strategy and the lack of detail on the review methodology and on the individual studies.