and 1 other(s)
Background and Aims Prehospital identification of large vessel occlusion (LVO) stroke may expedite treatment by direct transfer to comprehensive stroke centers (CSC) with endovascular capabilities. The Cincinnati Prehospital Stroke Scale (CPSS) is currently used by Emergency Medical Services (EMS) for prehospital stroke identification. We assessed whether a CPSS score of 3/3 can reliably detect LVO stroke. Method We conducted a retrospective analysis of all patients transferred by EMS for suspected stroke to a high-volume CSC over a 16-months period, halfway through which EMS redirection of patients with CPSS 3/3 to CSC was implemented (8 months before/8 months after). Charts and neuroimaging were reviewed to determine final diagnosis and presence of LVO. Results Of 376 patients evaluated, 223(59%) had a prehospital CPSS 3/3 score. Among those with CPSS 3/3, 152(68%) were diagnosed with acute ischemic stroke, including 64(29%) LVO strokes. The remainder of CPSS 3/3 were diagnosed with transient ischemic attack 7(3%), intracerebral hemorrhage 35(16%), or stroke mimic 29(13%). Only 9 patients with CPSS<3 had an LVO stroke. Following implementation, transfers for endovascular therapy from the three primary stroke centers affected by the redirection protocol decreased from 37 to 26, while evaluations at CSC for acute stroke increased from 105 to 271. Conclusion A high CPSS score is a simple and reliable tool for prehospital LVO detection. Nevertheless, EMS diversion of CPSS 3/3 to CSC substantially increases patient volume. Further studies are warranted to weigh the simplicity of CPSS 3/3 against more specific yet potentially more complex prehospital LVO detection scales.
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