Background and Purpose:
We tested whether adding two dysarthria and facial weakness, (PASS2+) to the three parameters of Prehospital Acute Stroke Severity (PASS) scale could improve the estimation of initial stroke severity in the emergency room.
We used five PASS2+ parameters (age/month, gaze, and arm weakness, dysarthria, and facial weakness) and National Institute of Health Stroke Scale (NIHSS) score prospectively collected from consecutive 509 ischemic stroke patients, who arrived at emergency room within 72 hours of the onset of symptoms. We developed two regression models to equate the correlation that the PASS parameters and the PASS2+ parameters each have with the actual NIHSS score of individual patients. The performances of the PASS and the PASS2+ were compared to see which model produces results closer to the NIHSS evaluation of stroke severity.
We acquired regression model equations with the 3 PASS parameters (NIHSS = 1.91 + [age/month] x 6.72 + [gaze] x 4.66 [Arm weakness] x 3.03) and the 5 parameters (NIHSS = 1.36 + [age/month] x 7.01 + [Arm weakness] x 2.69 + [gaze] x 4.41 + [dysarthria] x 0.92 + [facial weakness] x 0.99). The results showed that the PASS 2+ (r=0.752, p=0.001) has a higher correlation with the initial NIHSS evaluation than the PASS (r=0.715, p<0.001).
Improvement using PASS2+ parameters in estimation stroke severity would allow personnel to perform a more effective triage for acute stroke patients in the emergency room.