Detailed severity assessment of Cincinnati Prehospital Stroke Scale to detect large vessel occlusion in acute ischemic s
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RESEARCH ARTICLE
Open Access
Detailed severity assessment of Cincinnati Prehospital Stroke Scale to detect large vessel occlusion in acute ischemic stroke Gabor Tarkanyi1, Peter Csecsei1, Istvan Szegedi2, Evelin Feher3, Adam Annus3, Tihamer Molnar4 and Laszlo Szapary1*
Abstract Background: Selecting stroke patients with large vessel occlusion (LVO) based on prehospital stroke scales could provide a faster triage and transportation to a comprehensive stroke centre resulting a favourable outcome. We aimed here to explore the detailed severity assessment of Cincinnati Prehospital Stroke Scale (CPSS) to improve its ability to detect LVO in acute ischemic stroke (AIS) patients. Methods: A cross-sectional analysis was performed in a prospectively collected registry of consecutive patients with first ever AIS admitted within 6 h after symptom onset. On admission stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and the presence of LVO was confirmed by computed tomography angiography (CTA) as an endpoint. A detailed version of CPSS (d-CPSS) was designed based on the severity assessment of CPSS items derived from NIHSS. The ability of this scale to confirm an LVO was compared to CPSS and NIHSS respectively. Results: Using a ROC analysis, the AUC value of d-CPSS was significantly higher compared to the AUC value of CPSS itself (0.788 vs. 0.633, p < 0.001) and very similar to the AUC of NIHSS (0.795, p = 0.510). An optimal cut-off score was found as d-CPSS≥5 to discriminate the presence of LVO (sensitivity: 69.9%, specificity: 75.2%). Conclusion: A detailed severity assessment of CPSS items (upper extremity weakness, facial palsy and speech disturbance) could significantly increase the ability of CPSS to discriminate the presence of LVO in AIS patients. Keywords: Acute stroke, Large vessel occlusion, Stroke scales, Prehospital, Emergency medicine, Neurology
Background Endovascular thrombectomy (EVT) is effective to treat patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), which occurs in 20–40% of cases [1, 2]. There is a growing need for simple diagnostic methods that can detect these patients early on. A reliable LVO detection tool could be useful for emergency medical services (EMS) to select patients with a high * Correspondence: [email protected] 1 Department of Neurology, University of Pecs, 13 Ifjusag utja, Pecs 7624, Hungary Full list of author information is available at the end of the article
likelihood of LVO, as these patients may benefit from a direct transportation to an EVT capable comprehensive stroke centre (CSC) [3]. Cincinnati Prehospital Stroke Scale (CPSS) is a simple, three item scale, widely used by EMS. It is easy and quick to learn or perform and has good ability to identify potential stroke patients. Nonetheless, it only has moderate ability to detect AIS patients with LVO, however, important aspect is that CPSS only tests for the presence of three symptoms (facial palsy, upper extremity weakness and speech disturbance), but
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