Cincinnati Prehospital Stroke Scale

The Cincinnati Prehospital Stroke Scale (CPSS) is a widely recognized and efficient diagnostic tool designed to rapidly identify potential stroke victims in a pre-hospital environment. This scale provides first responders, especially emergency medical services (EMS) personnel, with a simplified method to recognize the classic signs of stroke and ensure timely transport to an appropriate medical facility.

Historical Background

Emerging from the need to enhance pre-hospital stroke care, the CPSS was developed in Cincinnati, providing a straightforward approach for early detection of stroke by pre-hospital providers. The foundational principle rests on the premise that early identification and expeditious treatment can drastically improve stroke outcomes<ref>Kothari, R. U., Pancioli, A., Liu, T., Brott, T., & Broderick, J. (1999). Cincinnati Prehospital Stroke Scale: Reproducibility and Validity. Annals of Emergency Medicine, 33(4), 373-378.</ref>.

Diagnostic Criteria

The CPSS evaluates three cardinal signs. An abnormal result in any one of these tests raises a strong suspicion for a stroke:

• Facial droop: The individual is asked to smile or show their teeth. An uneven or lopsided smile might indicate facial muscle weakness, a common sign of stroke.
• Arm drift: The patient is instructed to close their eyes and extend both arms out in front for 10 seconds. If one arm drifts downward or cannot be lifted, this suggests possible motor weakness associated with stroke.
• Abnormal Speech: The individual is asked to repeat a simple sentence, like "The sky is blue." Slurred speech or an inability to correctly repeat the sentence may indicate a speech/language disturbance indicative of stroke<ref>Kothari, R. U., Hall, K., Brott, T., & Broderick, J. (1997). Early stroke recognition: Developing an out-of-hospital NIH Stroke Scale. Academic Emergency Medicine, 4(10), 986-990.</ref>.

Importance and Clinical Application

Recognition of stroke in its initial stages is pivotal. Delays in identification can lead to a reduced therapeutic window for definitive treatments, such as thrombolytics. The CPSS serves as:

• A guide for EMS personnel to determine the need for rapid transport.
• A tool that can be taught to the general public to foster awareness and promote early activation of emergency services.
• A basis for pre-alerts to stroke centers, enabling them to prepare for potential acute stroke interventions<ref>Chen, S., Sun, H., Lei, Y., Gao, D., Wang, Y., Wee, A., ... & Liu, Y. (2015). Validation of the Cincinnati Prehospital Stroke Scale. Journal of Stroke and Cerebrovascular Diseases, 24(5), 1080-1084.</ref>.

Conclusion

The Cincinnati Prehospital Stroke Scale, while simple, is an invaluable tool in the early detection of strokes, ensuring prompt care and better patient outcomes. Its ease of use allows both medical professionals and laypersons to potentially recognize a stroke, emphasizing its critical role in public health and pre-hospital care.

References

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