External Validation of Prehospital Stroke Screen Scales for EMT: One Center Study

ABSTRACT

PURPOSE: We evaluated the validity of Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS) as prehospital stroke assessment tools for EMT-basics in Korea. METHODS: Patients (age> or =15 years) transported to a regional emergency center by 119 ambulances with one of 4 chiefs (altered mental status, weakness, dizziness, and syncope) were prospectively enrolled in the study during a 12-months period. Independent hospital EMT-basics in the emergency department triaged and recorded the LAPSS and the CPSS finding. On the basis of the final diagnosis by a neurologist, the sensitivity and specificity of the two methods were evaluated for all kinds of stroke and acute stroke within six hours of symptom onset. RESULTS: The study collected data for 653 patients. 47.2% of patients were male, with an average age of 62.2+/-15.3 years old. Their chief complaints were altered mental status (55.4%), weakness (9.3%), dizziness (16.7%), and syncope (18.5%). Of 89 stroke patients, 51.7% were diagnosed with ischemic stroke, 32.6% with hemorrhagic stroke, 15.7% with transient ischemic attack, and 6.9% with acute stroke. For all strokes, sensitivity and specificity of the LAPSS were 21.3% and 95.7%, and those of the CPSS were 44.9% and 80.7%, respectively. For acute stroke, sensitivity and specificity of the LAPSS were 22.2% and 94.6%, and those of the CPSS were 48.9% and 79.1%. CONCLUSION: US prehospital stroke assessment tools had low sensitivity in the hands of Korean EMT-basics in one regional emergency medical center. For improving prehospital diagnosis of stroke in Korean EMS, we should recommend the development of additional assessment tools.