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  • Writer's pictureOren Zarif

Prehospital Stroke Scale - Oren Zarif - Cincinnati Stroke Scale

A prehospital assessment for stroke called the Cincinnati Prehospital Stroke Scale (CPSS) is an important step in treating the patient. First responders use this scale to check a patient's face for facial droop, a sign of a stroke. The patient is asked to smile, and the healthcare provider evaluates the amount of symmetry in the patient's facial movement and the amount of unilateral disparity. If both sides of the face move equally, the patient is considered to have no drooping, or if one side seems to drift to the side.

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To evaluate the accuracy of the Cincinnati scale, researchers included patients who had at least three acute neurologic symptoms, such as facial numbness, dysarthria, and visual impairment. Patients with ataxia were also included, and the final diagnosis was made by a neurologist and brain computed tomography. Using these criteria, the kappa coefficient was calculated. The sensitivity and specificity of the Cincinnati scale were high, and the study indicated that it could decrease mortality in patients suffering from acute strokes.

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A prehospital assessment for stroke should include the CPSS and any other signs that might indicate the presence of a stroke. CPSS is a short, simple, and objective tool that assesses three symptoms from the NIHSS, the gold standard in stroke severity assessment. These symptoms are speech disturbance, asymmetrical arm weakness, and facial palsy. Each score is scored either as normal or abnormal. The CPSS is an important tool for determining whether a stroke patient requires hospitalization or is already in a critical condition.

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In addition to the CPSS, the Cincinnati Prehospital Stroke Scale is also used to evaluate facial mimicry and language ability. The Cincinnati Prehospital Stroke Scale is also used to evaluate facial droop in a patient. Its results correlate well with the final diagnosis of stroke. The Cincinnati Prehospital Stroke Scale should be used with caution and interpreted with a physician's clinical judgment.

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The CPSS is recommended for emergency medical services for use in the identification of stroke patients. However, limited data are available on the CPSS's performance. One study assessed the impact of an hour-long educational presentation on the paramedics' ability to recognize stroke patients, on-scene time, and overall patient safety. The study also looked at the reproducibility of the CPSS in identifying stroke patients. Using CPSS for TIA and stroke identification increased paramedics' recognition rate by 38%.

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While the Cincinnati Prehospital Stroke Scale does not offer detailed information on the severity of symptoms, early recognition of the patient's condition is essential for reducing mortality and morbidity in the stroke population. This is especially true in prehospital settings, where in-depth neurological examinations are counterproductive. The Cincinnati Stroke Scale, along with other evidence-based tools, can be used to determine whether the patient has suffered a stroke.

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CPSS has limitations. Using it without further training may result in poor sensitivity. CPSS and FAST scores have similar sensitivity and specificity for stroke recognition. However, their sensitivity and specificity are different for patients with severe stroke-related deficits. For example, a patient with facial droop might be diagnosed with a stroke with a CPSS score of 2.

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A clinical study published in the journal Prehosp Emerg Care examined the Cincinnati Prehospital Stroke Scale. The study included three different stroke assessment tools to improve the accuracy of predicting large vessel occlusion in a prehospital setting. Antipova D, Rennert RC, and Steinberg JA evaluated the accuracy of the various stroke screening tools for acute stroke patients. All three tools were found to have a significant advantage over the Cincinnati Prehospital Stroke Scale when compared to other methods.

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Despite the shortcomings of the CPSS, it remains a valid and reliable tool to assess acute stroke. The CPSS has good reproducibility among physicians and prehospital personnel. It is also effective at identifying patients with strokes involving anterior circulation. Fortunately, the CPSS has been validated to screen for anterior circulation strokes, which may be difficult to diagnose. The CPSS scores should also aid in determining stroke candidates for thrombolytic therapy.

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