The cincinnati prehospital stroke scale is a system used to diagnose a potential stroke in a prehospital setting. We conducted a retrospective singlecenter cohort study of patients presenting with suspicion of acute stroke from 2014 to 2015. Stroke severity score refers to a numerical scale used to quantify neurologic deficits in order. In the present study, the accuracy of cincinnati prehospital stroke scale was assessed. In its derivation study, which consisted of patients enrolled in thrombolysis and endovascular. Methods emergency medical services ems personnel and stroke physicians n326 rated each item of the nihss regarding suitability. When implementing these interventions, emphasis should be placed on minimizing delay in transport of the patient to a facility with the appropriate level of care, and ideally, these interventions should occur during ems transport. Determine cincinnati prehospital stroke scale cpss. By asking the suspected stroke victim to smile the family member or healthcare provider is able to see whether their smile is equal on both sides or if one side is not moving.
We hypothesize that a cutoff score of the cincinnati prehospital stroke scale cpss, a simple assessment tool currently used by emergency medical services ems providers, can be used to identify lvo. Early prehospital stroke recognition plays a fundamental role, because most clinical decisions should be made within the first hours after onset of symptoms. The cincinnati prehospital stroke severity scale cpsss was recently developed to predict large vessel occlusions lvo in patients with acute ischemic stroke ais. Facial drooping, sudden weakness or numbness in face, arm, leg or one side of body, loss of movement and sensation on one side of body, lack of muscle coordination ataxia, sudden vision loss in one eye, blurred and double vision, difficulty swallowing, decreased or increased level of responsiveness, speech disorder dysphasia, difficulty expressing thought or inability to speak expressive. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Jan 29, 2016 understanding the origins of the cincinnati prehospital stroke scale we all learned it in emtb class. Clinical predictors of accurate prehospital stroke recognition. Element of the nih stroke scale o limb ataxia present in 30% of ems unrecognized stroke cases in our pilot registry reasonable interrater reliability o kappa 0.
The cincinnati prehospital stroke scale cpss is used as an outofhospital assessment tool to help determine the neurologic status and ensure rapid recognition of a stroke. Sep 01, 2017 the snihssems shares full compatibility with the inhospital goldstandard nih stroke scale, but remains simple and easy to use. Validation of the cincinnati prehospital stroke scale ncbi. Pdf validation of the cincinnati prehospital stroke scale. If time allows, without delaying transport, initiate a second access line. Pdf diagnostic accuracy of cincinnati prehospital stroke scale. Stroke severity score refers to a numerical scale used to. Research article open access the use of cincinnati. Nov 20, 2011 the cincinnati prehospital stroke scale and glasgow coma scale are both used by healthcare providers to assess for symptoms of a stroke. Chapter 15 altered mental status flashcards quizlet. Cincinnati prehospital stroke scale april 27, 2014 by leave a comment the cincinnati prehospital stroke scale is a neurological exam used to assess patients with any suspected signs or symptoms of stroke. Cincinnati prehospital stroke scale facial droop ask the patient to show their teeth or smile. Original contribution cincinnati prehospital stroke scale. External validation of the cincinnati prehospital stroke.
Diagnosis is made prehospital now what stroke checklist stroke symptoms identified and recorded onset time or last known well time obtained and recorded. Mar 30, 2015 nihss, rapid arterial occlusion evaluation race scale, and cincinnati prehospital stroke severity cpss scale. The cincinnati prehospital stroke scale kothari r, et al, acad emerg med. Normalboth sides of face move equally abnormalone side ot face does not move. Appendix m cincinnati prehospital stroke scale 2019 johnson county emergency medical services page 148. Cincinnati prehospital stroke scale linkedin slideshare. Menu of stroke symptoms any one of the following symptoms ds drowsy, dizzy, double vision, dysarthria aphasia difficulty finding the right words, word salad, or mute not just slurred speech alone gazepalsy eyes deviated to one side, or eyes unable to cross midline neglect not able to pay attention to one side. The cpss was derived from the national institutes of health stroke scale developed in. Prehospital stroke triage and use of prehospital stroke scales. The cpss uses three physical findings to determine the presence of stroke and if any one of these findings are present, stroke should be suspected and treated accordingly. The cincinnati prehospital stroke scale abbreviated cpss is a system used to diagnose a potential stroke in a prehospital setting. Abnormal speech have the patient say you cant teach an old dog new tricks. This video is specifically provided by emtprep to assist members in preparing for the nremt exam and related skills sheets and.
Appendix g cincinnati prehospital stroke scale updated 02152018. Background and purposewe derived and validated the cincinnati prehospital stroke severity scale cpsss to identify patients with severe strokes and large. Make hospital contact following the format described in routine medical care g01 for stroke. Cincinnati prehospital stroke scale brain attack coalition. If cpss is 0, and last seen normal time, including wakeup stroke is.
University of cincinnati researchers have changed the. Assessing the validity of the cincinnati prehospital stroke scale and the medic prehospital assessment for code stroke in an urban emergency medical services agency jonathan r. The role of the cincinnati prehospital stroke scale in the emergency. Learn more to learn more and obtain free ems resources from medtronic s lifeline providing 247 support for healthcare professionals and patients call 8775267890. Arm drift patient closes eyes and extends both arms straight out, with palms up for 10 seconds both arms move the same or both arms do not move at all. Stroke assessment the cincinnati prehospital stroke scale facial droop have patient show teeth or smile normal abnormal both sides of. The cincinnati prehospital stroke scale abbreviated cpss is a system used to diagnose a. Reproducibility and validity from the department of emergency rashmi u kothari, md see. Louis school of medicine and ut southwestern medical center. It tests three signs for abnormal findings which may indicate that the patient is having a stroke. Instruct the patient to smile and show their teeth. Identifies facial paresis, arm drift, and abnormal speech. The tool that is most frequently mentioned in the literature and that helps ems personnel to accurately identify stroke tia symptoms is the cincinnati prehospital stroke scale cpss 25,26. Cincinnati prehospital stroke scale facial droop the patient shows teeth or smiles arm drift the patient closes their eyes and extends.
Jan 25, 2016 1918 influenza pandemic survivor interview. We sought to develop evidencebased recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols utilized by the 33 ems agencies in the state of california. Kothari ru, pancioli a, liu t, brott t, broderick j. Cincinnati prehospital stroke scale can identify large vessel. Results 5622 references were screened by title and or abstract. Ems stroke assessment guide american stroke association. Normal both sides of face move equally abnormal one side of face does not move as well as the other side arm drift patient closes eyes and extends both arms straight out for 10 seconds.
Data recorded included patient demographics, time of symptom onset, cincinnati prehospital stroke scale cpss score, glasgow coma scale score, national institutes of health stroke scale nihss score, emergency medical services ems impression, acute. Stroke patient with facel droop right side of face. When performed by a physician, it has a high sensitivity and specificity in identifying patients with stroke who are candidates for thrombolysis. The cincinnati prehospital stroke scale is a neurological exam used to assess patients with any suspected signs or symptoms of stroke. Stroke cincinnati prehospital stroke severity scale. If any one of the three tests shows abnormal findings, the patient may be having a stroke and should be transported to a hospital as soon as possible. The cincinnati prehospital stroke scale facial droop have patient show teeth or smile normal abnormal. The cincinnati prehospital stroke scale cpss is the core assessment tool for ems providers to evaluate possible stroke patients in the field. What is the cincinnati prehospital stroke scale cpss. San mateo county emergency medical services strokecvatia. Ability of laypersons to use the cincinnati prehospital stroke scale.
Cincinnati prehospital stroke scale this test is used to assess a patients facial muscles, arm movement and speech function. Assess patient using the cincinnati prehospital stroke scale cpss and document findings. Prehospital stroke assessment scales cincinnati prehospital stroke scale cpss identifies facial paresis, arm drift, and abnormal speech. The cincinnati prehospital stroke scale cpss checks three things. Read more about how this stroke scale should be implemented clinically and its interpretation below the form. Prehospital stroke care in virginia beachcqi report and update. When performed by a physician, it has a high sensitivity and specificity in. Diagnostic accuracy of cincinnati prehospital stroke. Perform routine alsbls medical care as directed in ems policy no. The patient is asked to show teeth or smile o normal both sides of face move equally well.
There are, however, several stroke scales, which were developed for prehospital emergency medical services ems and inhospital use. This was a retrospective crosssectional study done to assess accuracy of cincinnati scale in prediction of stroke probability in patients referred to the emergency department of poursina hospital, rasht, iran, 20 with neurologic symptoms. Recognizing the signs of acute stroke, the paramedics on scene alerted the greater cincinnati northern kentucky stroke team, the largest regional stroke. The cincinnati prehospital stroke scale cpss is a 3item scale based on a simplification of the national institutes of health nih stroke scale. Someone has a stroke about every 40 seconds and in 20, someone died from a stroke every four minutes. Normalboth sides of face move equally abnormalone side ot face does not move as well as the other side left. The role of the cincinnati prehospital stroke scale in the. The most commonly used tools for prehospital assessment of. Full text the role of the cincinnati prehospital stroke scale in the. This is not a part of the cincinnati prehospital stroke sale. When performed by a physician, it has a high sensitivity and specificity in identifying patients with stroke who are.
In the united states, emergency medical services ems protocols vary widely across jurisdictions. Understanding the origins of the cincinnati prehospital. Oct 06, 2015 the cincinnati prehospital stroke scale is a system used to diagnose a potential stroke in a prehospital setting. Pdf validation of the cincinnati prehospital stroke.
Studnek, phd, nremtp, andrew asimos, md, jodi dodds, md, doug swanson, md abstract objectives. Neurology a 3itemarm weakness, defects in speech, facial droopscale for stratifying stroke victims as candidates for thrombolytics. An expanded version of the cincinnati prehospital stroke scale to diagnose potential strokes in prehospital settings go to next section view publications authored by. The scale will be incorporated into a prehospital stroke triage algorithm in a large regional stroke network, but no prospective data are available yet, which is acknowledged as a limitation. Alert receiving hospital of potential stroke patient code stroke. Early recognition of stroke is one of the key concepts in the chain of survival as described by the american heart associationamerican stroke association stroke guidelines. Cincinnati prehospital stroke scale unitypoint health.
Objective to develop an nih stroke scale nihsscompatible, allinone scale for rapid and comprehensive prehospital stroke assessment including stroke recognition, severity grading and progression monitoring as well as prediction of large vessel occlusion lvo. Diagnostic accuracy of cincinnati prehospital stroke scale. Cincinnati prehospital stroke scale, face arm speech time, prehospital stroke, stroke south india abstract this is an open access journal, and ar cles are distribut ed under the terms of. Cincinnati prehospital stroke scale useful for laypeople. This project is supported in part by the nih specialized programs of translational research in acute stroke spotrias network, and ninds grant 3p50ns055977 to washington university in st. The most commonly used tools for prehospital assessment of stroke are the cincinnati prehospital stroke scale, cpss the face, arm, speech test, and. Jun 08, 2017 the cincinnati prehospital stroke severity scale is composed of 3 items. Normal patient uses correct word with not slurring abnormal patient slurs words, uses the wrong words, or is unable to speak.
In its derivation study, which consisted of patients enrolled in thrombolysis and endovascular therapy trials, cpsss had. Stroke assessment the clnclnnau prehospital stroke scale facial droop have patient show teeth or smile. The most commonly used tools for prehospital assessment of stroke are. Facial droop ask the patient to show their teeth or smile. The cincinnati prehospital stroke scale cpss is a validated screening tool whose utilization is suggested during triage. This cincinnati prehospital stroke scale calculator assesses the stroke probability through facial droop, arm drift and abnormal speech in cases of cerebrovascular accident. Cincinnati prehospital stroke scale nurses zone source. But prompt attention by a network of healthcare pros in cincinnati not only saved knights life but also allowed him to return to work within the week. Posterior stroke recognition in the prehospital setting.
Normal response is 0, abnormal is 1, maximum score is 3. Prehospital stroke scales in urban environments neurology. By asking the suspected stroke victim to smile the family member or healthcare provider is able to. Design and validation of a clinical scale for prehospital.