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Acute ischemic stroke
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Timely treatment relies not only on community awareness of stroke, but also on early identification by prehospital providers and hospital prenotification of a potential stroke patient. Research demonstrates that with hospital prenotification, more patients undergo timely evaluation, have shorter time to drug administration, and more eligible patients are treated with IV-alteplase (Lin et al., 2012). Evidence-based stroke scales to aid in stroke symptom recognition commonly include the Cincinnati Prehospital Stroke Scale (CPSS) or Los Angeles Prehospital Stroke Screen (LAPSS), though others exist (Brandler et al., 2014).
Assessment of the stroke patient
Published in Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees, Stroke in Practice, 2017
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees
Stroke assessment can be subdivided into pre-hospital and hospital assessment. A number of assessment tools have been developed in order to aid the prompt and accurate identification of stroke in the community and in primary care. Tools such as the Los Angeles Prehospital Stroke Screen (LAPSS) (seeTable 5.1), the Cincinnati Prehospital Stroke Scale (CPSS) (seeTable 5.2), and the Newcastle Face Arm Speech Test (FAST) (seeTable 5.3) have been developed. Each of these has different sensitivity and specificity and their own advantages and drawbacks but all serve nearly equally well their primary aim, which is to rapidly identify stroke.
Simplified Prehospital Prediction Rule to Estimate the Likelihood of 4 Types of Stroke: The 7-Item Japan Urgent Stroke Triage (JUST-7) Score
Published in Prehospital Emergency Care, 2021
Kazutaka Uchida, Shinichi Yoshimura, Fumihiro Sakakibara, Norito Kinjo, Hayato Araki, Shin Saito, Takeshi Morimoto
Stroke is a major health problem, and the second leading cause of death worldwide, with 5.5 million deaths attributed to stroke in 2016 (1). Many effective measures to prevent the incidence, treat the causes, and alleviate the symptoms or sequela of stroke have been developed over the past few decades (2–4). Among these effective modalities, the American Stroke Association recommends the recognition of stroke, activation of emergency medical services (EMS), triage to appropriate facilities, and designation of capable stroke centers (5). It is also recommended that EMS use a triage tool for patients with suspected stroke, such as the Cincinnati Prehospital Stroke Scale (CPSS), the Los Angeles Prehospital Stroke Screen (LAPSS), or the Field Assessment Stroke Triage for Emergency Destination (FAST-ED). These scales were commonly used and reported to have good performance in screening those patients with suspected acute large vessel occlusion (LVO) (6). However, a significant portion of patients with suspected stroke had other types of stroke than LVO and hemorrhagic strokes, such as intracranial hemorrhage (ICH) or subarachnoid hemorrhage (SAH), which can be life-threatening (7).
Acute ischemic stroke: improving access to intravenous tissue plasminogen activator
Published in Expert Review of Cardiovascular Therapy, 2020
Ashby C. Turner, Lee H. Schwamm, Mark R. Etherton
Lastly, as a common first point of contact for AIS patients, emergency medical services are in the position for early stroke recognition, which can result in appropriate triage and expedite stroke care. As a result, the American Heart Association (AHA)/American Stroke Association (ASA) recommends (Class I, Level of Evidence B-NR) emergency medical services utilize a prehospital stroke assessment tool to facilitate stroke recognition [45]. The Cincinnati Prehospital Stroke Scale and Los Angeles Prehospital Stroke Screen are two commonly used and validated scales that assess for the presence or absence of facial droop, extremity weakness, and/or speech difficulties (in the case of the Cincinnati Prehospital Stroke Scale) [46]. Use of a prehospital stroke assessment scale improves early stroke identification (positive predictive value of 51–64% [47,48]), which allows for prearrival notification at the receiving hospital.
Performance of the RACE Score for the Prehospital Identification of Large Vessel Occlusion Stroke in a Suburban/Rural EMS Service
Published in Prehospital Emergency Care, 2019
Robert L. Dickson, Remle P. Crowe, Casey Patrick, Kevin Crocker, Michael Aiken, Andrew Adams, Guy R. Gleisberg, Tyler Nichols, Christopher Mason, Ashish R. Panchal
The optimal stroke scale for use by EMS professionals to detect LVO in the prehospital setting remains to be determined. There has been a paucity of work on how scales perform when utilized in real-world prehospital settings by EMS providers in the United States (11, 12). In a 2018 review article by the American Heart Association and American Stroke Association on the optimal stroke screening tool for LVO, of 2,719 articles reviewed, only 36 met the eligibility criteria and only four studies specified that LVO screening tool was used in a prehospital environment (11). Of the pooled studies involving ischemic stroke conducted in the prehospital environment or in the emergency department (ED), there was no clear best tool as RACE, the Los Angeles Motor Scale (LAMS), and the three-item stroke scale demonstrated sensitivity and specificity of (67%, 85%), (38%, 87%), and (19%, 97%), respectively (11). The RACE scale performed similarly in our study with a sensitivity of 66% and specificity of 72%. A prospective study of the Cincinnati Stroke Triage Assessment Tool (C-STAT) that included 58 patients demonstrated higher sensitivity (71%) and similar specificity (70%) for LVO (16). Meanwhile, a positive score on all three elements of the Cincinnati Prehospital Stroke Scale demonstrated lower sensitivity (41%) and higher specificity (88%) (14).