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

Suh, Dong Bum; Shin, Sang Do; Kim, Yu Jin; Ahn, Ki Ok; Song, Kyung Joon; Park, Ju Ok; Jeong, Joong Sik

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.