Cincinnati Prehospital Stroke Scale: Reproducibility and Validity,☆☆,,★★

https://doi.org/10.1016/S0196-0644(99)70299-4Get rights and content

Abstract

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. [Kothari RU, Pancioli A, Liu T, Brott T, Broderick J: Cincinnati Prehospital Stroke Scale: Reproducibility and validity. Ann Emerg Med April 1999;33:373-378.]

Section snippets

INTRODUCTION

Early recognition and prompt medical evaluation is critical for the use of thrombolytic therapy for patients with acute ischemic stroke. Patients must be treated with tissue plasminogen activator (t-PA) within 180 minutes of symptom onset for the treatment to be effective.1 To accomplish this, clinical centers have emphasized “prehospital education” and “en-route notification by EMS personnel.”2 Anecdotal experience at the University of Cincinnati indicated that early notification by paramedics

MATERIALS AND METHODS

A total of 24 prehospital care providers (17 paramedics and 7 EMTs) from University of Cincinnati Mobile Care Unit were evaluated during 23 different sessions. Groups of 4 to 11 patients with or without a final discharge diagnosis of stroke were identified from the ED and the inpatient neurology service for each of these 23 different sessions. The testing physician identified a convenience sample of patients from the ED. An attempt was made to identify patients with chief complaints that were

RESULTS

A total of 860 scales were completed on 171 patients. Of these patients, 38 had a final diagnosis of stroke and 11 a final diagnosis of TIA. There was no difference in terms of race or sex between stroke/TIA and nonstroke patients; however, nonstroke patients were significantly younger (mean difference, 6.7 years, 95% CI, 11.7 to 1.7 years), as shown in Table 1.

. Patient demographics.

VariableAll PatientsStroke/TIANonstroke
No. patients17149122
Mean age (y)57.862.555.8
No. (%) male72 (42)17 (35)55

DISCUSSION

The rapid identification of potential stroke patients and early ED notification are important components of the prehospital management of stroke patients.9 The CPSS is a 3-item neurologic examination that was developed to assist paramedics and EMTs in identifying patients with stroke who are candidates for thrombolysis. This scale has been shown to be effective in identifying such stroke patients when it is performed by a trained physician.4 It can be taught in approximately 10 minutes and

Acknowledgements

We thank the men and women of the University of Cincinnati Mobile Care Unit for their assistance in this project.

References (14)

  • National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group

    Tissue plasminogen activator for acute ischemic stroke

    N Engl J Med

    (1995)
  • WG Barsan et al.

    Time of hospital presentation in patients with acute stroke

    Arch Intern Med

    (1993)
  • TG Brott et al.

    Urgent therapy for stroke: Part I. Pilot study of tissue plasminogen activator administered within 90 minutes

    Stroke

    (1992)
  • RU Kothari et al.

    Early stroke recognition: Developing an out-of-Hospital NIH Stroke Scale

    Acad Emerg Med

    (1997)
  • T Brott et al.

    Measurements of acute cerebral infarction: A clinical examination scale

    Stroke

    (1989)
  • P Lyden et al.

    Improved reliability of the NIH Stroke Scale using video training

    Stroke

    (1994)
  • GW Snedecor et al.

    Statistical Methods

There are more references available in the full text version of this article.

Cited by (500)

View all citing articles on Scopus

Supported by the Emergency Medicine Foundation through an unrestricted grant from Genentech.

☆☆

Address for reprints:Rashmi Kothari, MD, Department of Emergency Medicine, University of Cincinnati, Post Office Box 670769, Cincinnati, OH 45267-0769; 513-558-5281, fax 513-558-5791;E-mail [email protected].

0196-0644/99/$8.00 + 0

★★

47/1/96801

View full text