Cincinnati Prehospital Stroke Scale Can Identify Large Vessel Occlusion Stroke

Area of Science:

• Neurology
• Emergency Medicine
• Medical Diagnostics

Background:

• Accurate prehospital identification of acute ischemic stroke (AIS) with large vessel occlusion (LVO) is crucial for timely endovascular thrombectomy.
• The Cincinnati Prehospital Stroke Scale (CPSS) is a widely used assessment tool for emergency medical services (EMS).

Purpose of the Study:

• To determine if a specific CPSS score cut-off can reliably identify LVO in AIS patients.
• To evaluate the utility of the CPSS as a prehospital screening tool for LVO.

Main Methods:

• Prospective registry of AIS patients confirmed with head and neck vessel imaging for LVO.
• Abstraction of CPSS scores from EMS records.
• Statistical analysis including Spearman's rank correlation, Wilcoxon rank-sum test, Student's t-test, Youden index for optimal cut-off, and multivariate logistic regression.

Main Results:

• Of 138 analyzed patients, 43.7% had LVO.
• An optimal CPSS cut-off score of 3 predicted LVO with a Youden index of 0.29, sensitivity of 0.41, and specificity of 0.88.
• Patients with CPSS = 3 had a significantly higher likelihood of LVO (adjusted OR 5.7) compared to those with CPSS ≤ 2 (72.7% vs 34.3%, p < 0.0001).

Conclusions:

• A CPSS score of 3 is a reliable indicator for identifying LVO in AIS patients.
• EMS providers can potentially use this CPSS cut-off score for prehospital screening of suspected LVO, facilitating appropriate patient transport.