Directed Use of the Cincinnati Prehospital Stroke Scale by Laypersons

Abstract

BACKGROUND: The Cincinnati Prehospital Stroke Scale (CPSS) is a three-item examination that has been effective in the identification of stroke victims by health care professionals. However, assessment of the patient earlier in the chain of care, specifically by a 9-1-1 telecommunicator, may improve stroke outcomes. OBJECTIVES: To modify the CPSS for over-the-phone administration and to assess whether untrained adults can follow the CPSS instructions, identify deficits in stroke survivors, and return these findings to an investigator. METHODS: One hundred nonpatient visitors to an academic tertiary care emergency department were recruited. Each participant was brought to a room with a stroke survivor possessing unresolved symptoms from a previous stroke. The participant was telephoned by an investigator and led through administering the CPSS to the stroke survivor. The investigator noted whether the participant accurately administered CPSS instructions and whether normal or abnormal findings were returned. RESULTS: Participants correctly administered CPSS directions 98% of the time. For facial weakness, the sensitivity of the participants' assessments was 74% and the specificity was 94%. For arm weakness, the sensitivity was 97% and the specificity was 72%. For speech deficits, the sensitivity was 96% and the specificity was 96%. CONCLUSIONS: Untrained adults can use the CPSS to accurately identify stroke symptoms and can relay these findings to an investigator. Telecommunicator administration of the CPSS may allow for expedited prehospital triage of the stroke patient and delivery of resources in a timely manner and, given the limited time window for efficacious treatment, may lead to improved patient outcome.