Utility of the Kurashiki Prehospital Stroke Scale for hyperacute stroke

Our aim was to confirm the utility of paramedics using the Kurashiki Prehospital Stroke Scale (KPSS), with a maximum score of 13, for patients who may be eligible for administration of intravenous tissue plasminogen activator (IV t-PA).

The subjects comprised acute stroke and transient ischemic attack (TIA) patients transferred to our hospital by paramedics. We analyzed correlations between KPSS and the National Institutes of Health Stroke Scale (NIHSS). Patients admitted within 3 h of onset were categorized into 2 groups: KPSS ≥4 and KPSS <4. We compared the proportion of patients receiving IV t-PA between the groups.

Among 430 consecutive patients (mean age = 73 years; 266 men), paramedics recorded KPSS for 256 patients (59.5%). Excellent correlation was observed between KPSS and NIHSS in all 256 patients (R = 0.766; p < 0.001) and in 94 patients (ischemic stroke and TIA with symptoms on admission) admitted within 3 h of onset (R = 0.706; p < 0.001). Among these 94 patients, IV t-PA was more frequently given in the KPSS ≥4 group (30 of 58 patients, 51.7%) than in the KPSS <4 group (5 of 36 patients, 13.9%; p < 0.001). Arterial occlusion was more frequently observed in the KPSS ≥4 group (57.9 vs. 31.4%, p = 0.018). KPSS ≥4 was independently associated with administration of IV t-PA (odds ratio = 4.7; 95% confidence interval = 1.5-14.6, p = 0.008).

Reliable concordance between KPSS and NIHSS was found in acute stroke and TIA patients. KPSS ≥4 represents a good score to indicate prospective t-PA patients among those admitted within 3 h of stroke onset.