StrokeGuard: A Multi-Agent Guided System for Prehospital Stroke Assessment

Prehospital stroke assessment aims to accurately identify stroke symptoms and make rapid decisions through standardized procedures within an extremely narrow time window, thereby saving valuable time for subsequent treatment. In clinical practice, FAST-based scales are widely used for prehospital stroke assessment by issuing instructions that guide subjects to perform specific actions to screen facial, arm, and speech functions. However, in home and community settings, non-clinical users often encounter challenges such as inaccurate descriptions, incomplete symptom observation, and difficult operational procedures, which may lead to inaccurate or biased assessment results. To address these challenges, this paper presents StrokeGuard: a multi-agent guided system designed for prehospital stroke assessment that makes mobile FAST screening more standardized and executable. Specifically, to overcome the limitations of traditional single-agent systems in terms of procedural fault tolerance and user guidance capability, StrokeGuard adopts a dual-channel agent mechanism that separates formal assessment (i.e., facial palsy, arm weakness, speech impairment) from procedural support (e.g., step prompts, error correction, and real-time feedback). It guides the assessment process through multi-agent collaboration, dual-channel interaction, state-machine control, and stage-local fallback recovery mechanisms. Stage-specific scoring is delegated to constrained pretrained video assessment modules, while evidence source records are integrated with structured report generation. The user evaluation uses MATES-9, an exploratory scale for measuring user experience in multistep AI-guided tasks. In a simulated prehospital scenario, StrokeGuard improves the MATES-9 total score over a paper FAST-style form by 10.83 points, corresponding to a 23.8% relative increase.

Rating the Pitch, Not the Product: User Evaluations of LLMs Reflect Expectations More Than Performance

Imagine two users interact with the same LLM. One has been told it is the cutting-edge flagship model; the other, an older, weaker model. They walk away with markedly different ratings of its usefulness and intelligence, yet they used the same model. In a controlled study, 162 participants each used one of six LLMs from two families across three collaborative tasks, after first viewing a landing page that matched, overstated, or understated their model's true capability. This pre-interaction framing shifted user opinions and interaction behavior while task performance did not. Oversold users rated the model more favorably and used more directive prompting, while Undersold users wrote longer, more collaborative prompts. The quality of what users and the model produced together depended only on the model's true capability, not on what users were told. Participants' change in model impressions after use, measured across two impression measures, was not predicted by task performance ($β= -0.01$ and $0.11$, both n.s.), but by whether the model met users' expectations ($β= 0.47$ and $0.50$, both $p < .001$) and how confident they felt working with it ($β= 0.47$ and $0.36$, both $p < .001$). After interaction, users are still rating the pitch, not the product: user-elicited LLM evaluations, including the preference data driving public leaderboards, measure expectation management at least as much as the model itself.