Abstract 12493: Comparison of Prehospital Stroke Scales
Introduction: Stroke is a major cause of death and disability. The availability of time dependent therapies for stroke makes accurate triage critical. Recent data demonstrates superior outcomes in large vessel occlusion (LVO) after the adjunctive use of endovascular therapy. A sufficiently accurate pre-hospital scale is needed to appropriate LVO patients to the closest endovascular-capable center. Various prehospital stroke scales have been described in an attempt to help identify strokes. The objective of this study was to compare the sensitivity and specificity of the four most commonly used stroke scales, CPSS, LAPSS, LAMS and RACE in terms of their accuracy in identifying strokes and stroke severity. The National Institute of Health Stroke Scale serves as the gold standard for comparison.
Methods: Retrospective cohort study of a total of 1,293 patients transported from 2010 to 2013 by STAT MedEvac. Subjects had a suspected stroke, a prehospital NIHSS and a discharge diagnosis of stroke. The prehospital data were recorded in EMS charts by the EMS provider and used to establish scores for each of the four stroke scales analyzed. The hospital record was used to identify ischemic stroke (final discharge diagnosis) and the presence of LVO. Stroke identification and severity was determined by using the best cut off points for each of the scales. Using STATA12 the receiver operating characteristics were calculated for each scale.
Conclusions: Prehospital stroke scales differ significantly in sensitivity and specificity for stroke and LVO identification with most scores having low sensitivity for both stroke and LVO detection. Although the commonly used CPSS has a fairly high sensitivity its specificity is low which could lead to a potential over-triage of patients. The results of the study show that none of these scales has sufficient accuracy to identify strokes and eliminate stroke mimics. A new tool is needed to improve prehospital stroke and LVO.
Author Disclosures: D. Sequeira: None. C. Martin-Gill: None. F.X. Guyette: None. A.P. Jadhav: None.
- © 2015 by American Heart Association, Inc.