Cincinnati Prehospital Stroke Scale Can Identify Large Vessel Occlusion Stroke

Christopher Thomas Richards, Ryan Huebinger, Katie L. Tataris, Joseph M. Weber, Laura Eggers, Eddie Markul, Leslee Stein-Spencer, Kenneth Pearlman, Jane Louise Holl, Shyam Prabhakaran

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: Accurate prehospital identification of patients with acute ischemic stroke (AIS) from large vessel occlusion (LVO) facilitates direct transport to hospitals that perform endovascular thrombectomy. We hypothesize that a cut-off 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. Methods: Consecutively enrolled, confirmed AIS patients arriving via EMS between August 2012 and April 2014 at a high-volume stroke center in a large city with a single municipal EMS provider agency were identified in a prospective, single-center registry. Head and neck vessel imaging confirmed LVO. CPSS scores were abstracted from prehospital EMS records. Spearman's rank correlation, Wilcoxon rank-sum test, and Student's t-test were performed. Cohen's kappa was calculated between CPSS abstractors. The Youden index identified the optimal CPSS cut-off. Multivariate logistic regression controlling for age, sex, and race determined the odds ratio (OR) for LVO. Results: Of 144 eligible patients, 138 (95.8%) had CPSS scores in the EMS record and were included for analysis. The median age was 69 (IQR 58–81) years. Vessel imaging was performed in 97.9% of patients at a median of 5.9 (IQR 3.6–10.2) hours from hospital arrival, and 43.7% had an LVO. Intravenous tissue plasminogen activator was administered to 29 patients, in whom 12 had no LVO on subsequent vessel imaging. The optimal CPSS cut-off predicting LVO was 3, with a Youden index of 0.29, sensitivity of 0.41, and specificity of 0.88. The adjusted OR for LVO with CPSS = 3 was 5.7 (95% CI 2.3–14.1). Among patients with CPSS = 3, 72.7% had an LVO, compared with 34.3% of patients with CPSS ≤ 2 (p < 0.0001). Conclusions: A CPSS score of 3 reliably identifies LVO in AIS patients. EMS providers may be able to use the CPSS, a simple, widely adopted prehospital stroke assessment tool, with a cut-off score to screen for patients with suspected LVO.

Original languageEnglish (US)
Pages (from-to)312-318
Number of pages7
JournalPrehospital Emergency Care
Volume22
Issue number3
DOIs
StatePublished - May 4 2018

Fingerprint

Stroke
Emergency Medical Services
Nonparametric Statistics
Medical Records
Odds Ratio
Thrombectomy
Tissue Plasminogen Activator
Registries
Neck
Logistic Models
Head
Students
Sensitivity and Specificity

Keywords

  • Stroke
  • brain infarction
  • emergency medical services
  • emergency medical technicians
  • prehospital emergency care

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Richards, C. T., Huebinger, R., Tataris, K. L., Weber, J. M., Eggers, L., Markul, E., ... Prabhakaran, S. (2018). Cincinnati Prehospital Stroke Scale Can Identify Large Vessel Occlusion Stroke. Prehospital Emergency Care, 22(3), 312-318. https://doi.org/10.1080/10903127.2017.1387629
Richards, Christopher Thomas ; Huebinger, Ryan ; Tataris, Katie L. ; Weber, Joseph M. ; Eggers, Laura ; Markul, Eddie ; Stein-Spencer, Leslee ; Pearlman, Kenneth ; Holl, Jane Louise ; Prabhakaran, Shyam. / Cincinnati Prehospital Stroke Scale Can Identify Large Vessel Occlusion Stroke. In: Prehospital Emergency Care. 2018 ; Vol. 22, No. 3. pp. 312-318.
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Richards, CT, Huebinger, R, Tataris, KL, Weber, JM, Eggers, L, Markul, E, Stein-Spencer, L, Pearlman, K, Holl, JL & Prabhakaran, S 2018, 'Cincinnati Prehospital Stroke Scale Can Identify Large Vessel Occlusion Stroke' Prehospital Emergency Care, vol. 22, no. 3, pp. 312-318. https://doi.org/10.1080/10903127.2017.1387629

Cincinnati Prehospital Stroke Scale Can Identify Large Vessel Occlusion Stroke. / Richards, Christopher Thomas; Huebinger, Ryan; Tataris, Katie L.; Weber, Joseph M.; Eggers, Laura; Markul, Eddie; Stein-Spencer, Leslee; Pearlman, Kenneth; Holl, Jane Louise; Prabhakaran, Shyam.

In: Prehospital Emergency Care, Vol. 22, No. 3, 04.05.2018, p. 312-318.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cincinnati Prehospital Stroke Scale Can Identify Large Vessel Occlusion Stroke

AU - Richards, Christopher Thomas

AU - Huebinger, Ryan

AU - Tataris, Katie L.

AU - Weber, Joseph M.

AU - Eggers, Laura

AU - Markul, Eddie

AU - Stein-Spencer, Leslee

AU - Pearlman, Kenneth

AU - Holl, Jane Louise

AU - Prabhakaran, Shyam

PY - 2018/5/4

Y1 - 2018/5/4

N2 - Objective: Accurate prehospital identification of patients with acute ischemic stroke (AIS) from large vessel occlusion (LVO) facilitates direct transport to hospitals that perform endovascular thrombectomy. We hypothesize that a cut-off 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. Methods: Consecutively enrolled, confirmed AIS patients arriving via EMS between August 2012 and April 2014 at a high-volume stroke center in a large city with a single municipal EMS provider agency were identified in a prospective, single-center registry. Head and neck vessel imaging confirmed LVO. CPSS scores were abstracted from prehospital EMS records. Spearman's rank correlation, Wilcoxon rank-sum test, and Student's t-test were performed. Cohen's kappa was calculated between CPSS abstractors. The Youden index identified the optimal CPSS cut-off. Multivariate logistic regression controlling for age, sex, and race determined the odds ratio (OR) for LVO. Results: Of 144 eligible patients, 138 (95.8%) had CPSS scores in the EMS record and were included for analysis. The median age was 69 (IQR 58–81) years. Vessel imaging was performed in 97.9% of patients at a median of 5.9 (IQR 3.6–10.2) hours from hospital arrival, and 43.7% had an LVO. Intravenous tissue plasminogen activator was administered to 29 patients, in whom 12 had no LVO on subsequent vessel imaging. The optimal CPSS cut-off predicting LVO was 3, with a Youden index of 0.29, sensitivity of 0.41, and specificity of 0.88. The adjusted OR for LVO with CPSS = 3 was 5.7 (95% CI 2.3–14.1). Among patients with CPSS = 3, 72.7% had an LVO, compared with 34.3% of patients with CPSS ≤ 2 (p < 0.0001). Conclusions: A CPSS score of 3 reliably identifies LVO in AIS patients. EMS providers may be able to use the CPSS, a simple, widely adopted prehospital stroke assessment tool, with a cut-off score to screen for patients with suspected LVO.

AB - Objective: Accurate prehospital identification of patients with acute ischemic stroke (AIS) from large vessel occlusion (LVO) facilitates direct transport to hospitals that perform endovascular thrombectomy. We hypothesize that a cut-off 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. Methods: Consecutively enrolled, confirmed AIS patients arriving via EMS between August 2012 and April 2014 at a high-volume stroke center in a large city with a single municipal EMS provider agency were identified in a prospective, single-center registry. Head and neck vessel imaging confirmed LVO. CPSS scores were abstracted from prehospital EMS records. Spearman's rank correlation, Wilcoxon rank-sum test, and Student's t-test were performed. Cohen's kappa was calculated between CPSS abstractors. The Youden index identified the optimal CPSS cut-off. Multivariate logistic regression controlling for age, sex, and race determined the odds ratio (OR) for LVO. Results: Of 144 eligible patients, 138 (95.8%) had CPSS scores in the EMS record and were included for analysis. The median age was 69 (IQR 58–81) years. Vessel imaging was performed in 97.9% of patients at a median of 5.9 (IQR 3.6–10.2) hours from hospital arrival, and 43.7% had an LVO. Intravenous tissue plasminogen activator was administered to 29 patients, in whom 12 had no LVO on subsequent vessel imaging. The optimal CPSS cut-off predicting LVO was 3, with a Youden index of 0.29, sensitivity of 0.41, and specificity of 0.88. The adjusted OR for LVO with CPSS = 3 was 5.7 (95% CI 2.3–14.1). Among patients with CPSS = 3, 72.7% had an LVO, compared with 34.3% of patients with CPSS ≤ 2 (p < 0.0001). Conclusions: A CPSS score of 3 reliably identifies LVO in AIS patients. EMS providers may be able to use the CPSS, a simple, widely adopted prehospital stroke assessment tool, with a cut-off score to screen for patients with suspected LVO.

KW - Stroke

KW - brain infarction

KW - emergency medical services

KW - emergency medical technicians

KW - prehospital emergency care

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