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Cincinnati Prehospital Stroke Scale: reproducibility and validity
R U Kothari1, A Pancioli, T Liu
1Department of Emergency Medicine and the Departmentof Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA. rashmikant.kothari@uc.edu
Insights
The Cincinnati Prehospital Stroke Scale (CPSS) demonstrates excellent reproducibility and good validity for prehospital providers in identifying stroke patients eligible for thrombolytic therapy, particularly those with anterior circulation strokes.
Area of Science:
- Neurology
- Emergency Medicine
- Clinical Assessment Tools
Background:
- The Cincinnati Prehospital Stroke Scale (CPSS) is a simplified version of the National Institutes of Health (NIH) Stroke Scale.
- Physician-administered CPSS shows high sensitivity and specificity for identifying stroke patients suitable for thrombolysis.
Purpose of the Study:
- To validate and verify the reproducibility of the CPSS when used by prehospital providers.
- Assess the CPSS's utility in prehospital stroke identification.
Main Methods:
- The CPSS was administered by prehospital providers (paramedics and EMTs) concurrently with a physician using the NIH Stroke Scale as the gold standard.
- Data collected from 171 patients, with 49 diagnosed with stroke or transient ischemic attack.
Main Results:
- High reproducibility was found among prehospital providers for the total CPSS score (intraclass correlation coefficient [rI]=.89) and individual items (arm weakness, speech, facial droop).
- Excellent agreement was observed between prehospital providers and physicians for the total score (rI=.92) and scale items.
- The CPSS demonstrated 66% sensitivity and 87% specificity in identifying stroke patients, with 88% sensitivity for anterior circulation strokes.
Conclusions:
- The CPSS exhibits excellent reproducibility among prehospital personnel and physicians.
- The scale is valid for identifying stroke patients who may benefit from thrombolytic therapy, especially those with anterior circulation stroke.
Study Objective:
The Cincinnati Prehospital Stroke Scale (CPSS) is a 3-item scale based on a simplification of the National Institutes of Health (NIH) Stroke Scale. When performed by a physician, it has a high sensitivity and specificity in identifying patients with stroke who are candidates for thrombolysis. The objective of this study was to validate and verify the reproducibility of the CPSS when used by prehospital providers.
Methods:
The CPSS was performed and scored by a physician certified in the use of the NIH Stroke Scale (gold standard). Simultaneously, a group of 4 paramedics and EMTs scored the same patient.
Results:
A total of 860 scales were completed on a convenience sample of 171 patients from the emergency department and neurology inpatient service. Of these patients, 49 had a diagnosis of stroke or transient ischemic attack. High reproducibility was observed among prehospital providers for total score (intraclass correlation coefficient [rI],.89; 95% confidence interval [CI],.87 to.92) and for each scale item: arm weakness, speech, and facial droop (.91,.84, and.75, respectively). There was excellent intraclass correlation between the physician and the prehospital providers for total score (rI,.92; 95% CI,.89 to.93) and for the specific items of the scale (.91,.87, and.78, respectively). Observation by the physician of an abnormality in any 1 of the 3 stroke scale items had a sensitivity of 66% and specificity of 87% in identifying a stroke patient. The sensitivity was 88% for identification of patients with anterior circulation strokes.
Conclusion:
The CPSS has excellent reproducibility among prehospital personnel and physicians. It has good validity in identifying patients with stroke who are candidates for thrombolytic therapy, especially those with anterior circulation stroke.