Brief ReportPredictive value of the Cincinnati Prehospital Stroke Scale for identifying thrombolytic candidates in acute ischemic stroke☆
Introduction
The clinical catchphrase “time is brain” reflects the time-sensitive nature of stroke. The ultimate goal of stroke care is to minimize acute brain injury and maximize patient recovery [1]. Good functional outcome after acute stroke begins with immediate recognition of the stroke as it occurs [2]. The Cincinnati Prehospital Stroke Scale (CPSS) is an effective tool to identify stroke, requiring only 30 to 60 seconds, that can be used by emergency medical service (EMS) personnel and laypersons [3]. The CPSS has shown excellent reproducibility among prehospital care providers and can accurately identify candidates for thrombolytic therapy [4].
Intra-arterial thrombolysis and intravenous administration of intravenous tissue plasminogen activator (IV-tPA) can improve outcomes for many patients if performed shortly after onset of acute stroke [5], [6]. EMS personnel should consider triage to the appropriate hospital based on its stroke care capability and distance. A rapid triage system for assessing stroke severity should be used in the emergency department (ED) to minimize delays to diagnosis and therapy [1]. Although CPSS facilitates rapid recognition of acute stroke, its ability to assess stroke severity is unclear [7].
We investigated the usefulness of the CPSS to determine stroke severity by comparing CPSS and National Institutes of Health Stroke Scale (NIHSS) scores in patients who may be candidates for thrombolysis on arrival at the hospital within 6 hours of symptom onset.
Section snippets
Methods
We carried out a retrospective analysis of a prospective registry database of all consecutive patients included in the brain salvage through emergency stroke therapy (BEST) program in a tertiary academic hospital with an annual ED census of 65,000 visits. The institutional review board of our institute approved this study. We included patients with ischemic stroke or transient ischemic attack who at the ED within 6 hours of symptom onset between Sep 1, 2010, and Sep 30, 2011.
In our hospital,
Results
The study included a total of 284 (38.5%) consecutive patients with ischemic stroke or transient ischemic attack as final diagnosis who arrived at the ED within 6 hours of symptom onset. Among the 184 (64.8%) patients admitted within 3 hours of onset, thrombolytic therapy consisted of IV-tPA (n = 41, 22.3%) or the sequential combination of t-PA and IA-UK (n = 11, 6.0%). The single therapy IA-UK was given to 14 patients (< 3 hours onset; n = 5, ≥ 3 hours onset; n = 9). A strong correlation was
Discussion
The NIHSS is a useful clinical tool for the assessment of stroke severity and provides important information regarding early prognosis and treatment decisions [5]. However, this 15-item stroke scoring scale is relatively time-consuming and cumbersome in the field. The simplified 3-item CPSS, which is based on the NIHSS, rapidly identifies acute stroke by evaluating weakness in the face and arm and difficulty with speech. The Face Arm Speech Time message based on the CPSS is being reintroduced
Conclusion
The CPSS is an effective prehospital stroke scale that can assess stroke severity and identify candidates for thrombolytic therapy among patients with acute ischemic stroke within 6 hours of symptom onset.
Acknowledgments
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2013R1A1A2009391).
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2015, ResuscitationCitation Excerpt :Early admission to a stroke centre and early treatment greatly improves stroke outcome and highlights the need for first aid providers to quickly recognise stroke symptoms.828,829 There is good evidence that the use of a stroke-screening tool improves the time to definitive treatment.830–833 Use a stroke assessment system to decrease the time to recognition and definitive treatment for individuals with suspected acute stroke.
European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First aid
2015, ResuscitationCitation Excerpt :The stroke management goal is to administer definitive treatment early in the course of the stroke and to benefit from the best therapies, e.g. receiving clot-busting treatment within the first hours of the onset of stroke symptoms or in the case of intra-cerebral haemorrhage, a surgical intervention.26 There is good evidence that the use of a stroke-screening tool improves the time to definitive treatment.27–30 First aid providers should be trained to utilize a simple stroke assessment tool such as the Face, Arm, Speech, Test scale (FAST)31–35 or the Cincinnati Prehospital Stroke Scale (CPSS)31,36,37 to identify individuals with suspected acute stroke.
Part 9: First aid. 2015 International Consensus on First Aid Science with Treatment Recommendations
2015, ResuscitationCitation Excerpt :For the FASTER scale (measured as number of patients who received thrombolytic), we identified very-low-quality evidence (downgraded for risk of bias) from 1 observational study49 enrolling 34 patients showing benefit where 19.1% patients who had the scale applied received fibrinolytic compared with 7.5% who did not have the scale applied (RR, 0.87; 95% CI, 0.78–0.98). For CPSS (measured with patients who received fibrinolytic), we identified moderate-quality evidence from 1 observational study50 enrolling 308 patients showing benefit where 45.7% patients who had the scale applied received fibrinolytic compared with 2.1% who did not have the scale applied (RR, 22.2%; 95% CI, 7.14–69.1). For the important outcome of recognition of stroke (diagnostic studies, outcome defined as correct stroke diagnosis), we identified low-quality evidence (all downgraded for risk of bias) from 22 observational studies44,46–48,51–68 enrolling a total of 30 635 patients, studying 8 different stroke screening assessment systems, showing diagnostic performance across all stroke screening systems of sensitivity ranging from 0.41 to 0.97 and specificity ranging from 0.13 to 1.00.
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2014, American Journal of Emergency MedicineCitation Excerpt :Nevertheless, in a cerebellar or brainstem ischemia, vertigo can be the only symptom [4]. The Cincinnati Prehospital Stroke Scale is an effective tool to identify stroke, requiring only 30 to 60 seconds at emergency units [5]. However, the Cincinnati Pre-hospital Stroke Scale is not susceptible in patients with LMI.
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Conflict of interests: None.