Predictive value of the Cincinnati Prehospital Stroke Scale for identifying thrombolytic candidates in acute ischemic stroke

• Published in: The American journal of emergency medicine 2013-12, Vol.31 (12), p.1699-1702
• Main Authors: You, Je Sung, MD, Chung, Sung Phil, MD, Chung, Hyun Soo, MD, Lee, Hye Sun, MS, Park, Jong Woo, MD, Kim, Hyun Jong, MD, Lee, Shin Ho, MD, Park, Incheol, MD, Lee, Hahn Shick, MD
• Format: Article
• Language: English
• Subjects: Aged; Brain Ischemia - drug therapy; Brain research; Cardiac arrhythmia; Cardiovascular disease; Cohort Studies; Emergency; Emergency medical care; Emergency medical services; Emergency Medical Services - methods; Female; Fibrinolytic Agents - therapeutic use; Heart attacks; Hospitals; Humans; Logistic Models; Male; Medical imaging; Middle Aged; Multivariate Analysis; NMR; Nuclear magnetic resonance; Patient Selection; Regression analysis; Retrospective Studies; Severity of Illness Index; Statistical analysis; Stroke; Stroke - drug therapy; Technicians; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Urokinase-Type Plasminogen Activator - therapeutic use
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2013.08.029

Abstract Background Despite the usefulness of the Cincinnati Prehospital Stroke Scale (CPSS) for rapid recognition of acute stroke, its ability to assess stroke severity is unclear. We investigated the usefulness of CPSS for assessment of stroke severity by comparing CPSS and National Institutes of Health Stroke Scale (NIHSS) scores in patients who were candidates for thrombolytic therapy at hospital admission within 6 hours of symptom onset. Methods We conducted a retrospective analysis of a prospective registry database of consecutive patients included in the brain salvage through emergency stroke therapy program. In the emergency department, CPSS score was determined by emergency medical technicians. A CPSS cut-off score was estimated for candidates of thrombolytic therapy by comparing CPSS and NIHSS scores of patients who actually received thrombolytic therapy. Clinical outcomes were compared among patients with scores near the cut-off. Independent predictors of outcome were evaluated by multivariate logistic regression analysis. Results Strong correlations were observed between CPSS and NIHSS scores within 3 hours ( R = 0.778) and 6 hours ( R = 0.769) of symptom onset. The optimal cut-off score was 2 for CPSS was associated with actual usage of intravenous tissue plasminogen activator (odds ratio [OR] 34.455; 95% confidence interval [CI] 7.924-149.817, P < .0001) and actual usage of thrombolytic therapy overall (intravenous tissue plasminogen activator or intra-arterial urokinase) (OR 36.310; 95% CI 10.826-121.782, P < .0001). Conclusion The CPSS is an effective prehospital stroke scale for the determination of stroke severity and identification of candidates for thrombolytic therapy.