Related Experiment Video
Updated: Aug 13, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Prehospital Validation of the Scale to Identify Large Vessel Occlusion in Suspected Stroke Patients
Takahiro Shimizu1, Yasuhiro Hasegawa2,3, Yoshifumi Tsuboi4
1Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan.
Insights
Improving prehospital stroke assessment for large vessel occlusion (LVO) is crucial. The MPSS+4 scale, integrating LVO signs, significantly enhanced LVO detection and identified candidates for endovascular therapy (EVT).
Area of Science:
- Neurology
- Emergency Medicine
- Medical Diagnostics
Background:
- Prehospital identification and transfer of large vessel occlusion (LVO) stroke patients to thrombectomy-capable stroke centers (TSCs) for endovascular thrombectomy (EVT) presents significant challenges.
- Established scales like the Cincinnati Prehospital Stroke Scale (CPSS) and Maria Prehospital Stroke Scale (MPSS) are used for stroke assessment.
Purpose of the Study:
- To evaluate the clinimetric performance of existing scales (CPSS, MPSS) and novel scales incorporating LVO-specific items.
- To determine if integrating aphasia, unilateral spatial neglect (USN), conjugate eye deviation, and atrial fibrillation detection improves prehospital LVO screening.
Main Methods:
- Retrospective analysis of prehospital electronic records linked with hospital data (Kawasaki City, April 2023-March 2024).
- Four scales were compared: CPSS, CPSS+4 (CPSS with 4 LVO items), MPSS, and MPSS+4 (MPSS with 4 LVO items).
- Predictive performance for LVO detection was assessed using Area Under the Receiver Operating Characteristic Curve (AUROC).
Main Results:
- Of 1,653 patients, 207 (12.5%) had LVO.
- The MPSS+4 scale demonstrated the highest predictive performance for LVO (AUROC 0.768).
- The addition of four LVO-related items significantly improved LVO prediction for both MPSS and CPSS (p < 0.001).
- Higher MPSS+4 scores correlated with increased likelihood of EVT, with odds ratios rising from 2.97 to 100.59 for scores 2-9 compared to a score of 1.
Conclusions:
- Integrating LVO-specific items into prehospital stroke scales significantly enhances diagnostic accuracy for LVO.
- The MPSS+4 scale outperformed all other evaluated tools in predicting LVO.
- The MPSS+4 scale shows promise as a practical tool for prehospital triage and identification of EVT candidates by emergency medical technicians.
Introduction:
Timely identification and transfer of patients with large vessel occlusion (LVO) to thrombectomy-capable stroke centers (TSCs) for endovascular thrombectomy (EVT) remains a major challenge in prehospital stroke care. This study evaluated the clinimetric performance of the Cincinnati Prehospital Stroke Scale (CPSS), the Maria Prehospital Stroke Scale (MPSS) and novel LVO screening scales created by integrating four LVO-related items into these established prehospital assessments.
Methods:
Using prehospital electronic records linked with hospital data across Kawasaki City from April 2023 to March 2024, we retrospectively analyzed whether the addition of aphasia, unilateral spatial neglect, conjugate eye deviation, and atrial fibrillation (via ambulance ECG) improved prehospital LVO detection. These items were incorporated into the MPSS (MPSS+4 scale) and CPSS (CPSS+4 scale), and the predictive performance of four tools: CPSS, CPSS+4 scale, MPSS, and MPSS+4 scale was compared.
Results:
Among 1,653 transported patients, 207 (12.5%) had LVO. MPSS+4 scale demonstrated the highest predictive performance for LVO (AUROC 0.768). The addition of the four LVO-related items significantly improved LVO prediction for both MPSS and CPSS (p < 0.001 for each). Higher MPSS+4 scale scores were strongly and progressively associated with the likelihood of receiving EVT after hospital arrival. Adjusted odds ratios increased from 2.97 to 100.59 for scores 2-9 compared with a score of 1.
Conclusion:
Incorporating LVO-related items into prehospital stroke assessment substantially improved diagnostic precision for LVO, with MPSS+4 scale outperforming all other tools. The strong association between MPSS+4 scale scores and subsequent EVT implementation suggests that MPSS+4 scale may serve as a practical, clinically meaningful instrument for emergency medical technicians in prehospital triage of suspected acute stroke and identification of EVT candidates.
