Prospective Italian Validation of SMS in Patients With Suspected Acute Stroke

NCT07601659 — Not yet recruiting, 1000 participants, Fondazione Policlinico Universitario Agostino Gemelli IRCCS

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Prospective Italian Multicenter Study for the Validation of the Stroke Mimics Score (SMS) in Patients With Suspected Acute Stroke

RegistryNCT07601659, acronym PIVA-SMS
StatusNot yet recruiting
Study typeObservational
Enrollment1000 (Estimated)
SponsorFondazione Policlinico Universitario Agostino Gemelli IRCCS (Other)
ConditionsCerebrovascular Event, Acute Ischemic Stroke, Intracerebral Hemorrhage, TIA (Transient Ischemic Attack), Stroke
Datesstart 2026-06-01 (estimated), primary completion 2026-12-01 (estimated), completion 2027-06-01 (estimated), first posted 2026-05-22, last updated 2026-05-22

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-Summary

The overall objective of the study is to prospectively validate the diagnostic accuracy of the Stroke Mimics Score (SMS). This score is calculated using information collected at the time of the patient's arrival in the Emergency Department (triage) and may assist clinicians in distinguishing between:

1. cerebrovascular events (ischemic stroke, intracerebral hemorrhage, and transient ischemic attack \[TIA\]),
2. stroke mimics (i.e., conditions that present with stroke-like symptoms but without actual infarction of brain tissue).

In addition, the study aims to compare its results with other existing tools and to evaluate its performance across different patient groups.

Specifically, the present research seeks to generate data on the reliability of the SMS tool in providing an accurate diagnosis.

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+Outcome measures

Primary outcomes

  • The rate of accuracy of Stroke Mimics Score (SMS) [through study completion, about 1 year]: Diagnostic accuracy of the Stroke Mimics Score (SMS) in discriminating between: 1. cerebrovascular events (CVE), 2. stroke mimics (SM), assessed by: Area Under the Receiver Operating Characteristic Curve (AUROC). The AUROC will be calculated with a 95% confidence interval. An AUROC value significantly higher than 0.70 will be considered indicative of an acceptable discriminative ability of the score.

Secondary outcomes

  • Analyses across clinical subgroups [through study completion, about 1 year]: To evaluate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), score calibration, the performance of the grouped version (SMSg), comparison with FABS and TMS, and analyses across clinical subgroups.

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Age ≥ 18 years at the time of presentation to the Emergency Department.
* Presentation to the Emergency Department with a clinical suspicion of acute stroke, identified at nursing triage and/or through activation of the stroke pathway.
* Presentation to the Emergency Department during the 6-month prospective enrollment period.
* Feasibility of real-time collection of the data required to calculate the Stroke Mimics Score (SMS), including:

age, systolic blood pressure, presence/absence of seizure at onset, presence/absence of headache at onset, presence/absence of confusion at onset, presence/absence of syncope at onset, presence/absence of isolated sensory deficit, presence/absence of motor deficit, history of coronary artery disease, history of prior stroke or transient ischemic attack (TIA).

* Availability of a final hospital discharge diagnosis at the end of hospitalization or Emergency Department observation.
* Signed informed consent from the patient or caregiver. If the patient is unconscious upon arrival at the Emergency Department, deferred consent will be applied.

Exclusion Criteria:

* Age < 18 years.
* Inability to fully collect the data required to calculate the Stroke Mimics Score (SMS).
* Absence of a clearly defined final hospital discharge diagnosis.
* Voluntary discharge, transfer, or death before completion of the diagnostic workup, in the absence of a reliable diagnosis.
* Repeated Emergency Department visits for the same clinical event (only the first visit will be considered).

+Investigators

  • Giovanni Frisullo, Principal investigator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS