Yonsei Med J.  2014 Mar;55(2):410-416.

The Usefulness of the Kurashiki Prehospital Stroke Scale in Identifying Thrombolytic Candidates in Acute Ischemic Stroke

• Jang J
• Chung SP
• Park I
• You JS
• Lee HS
• Park JW
• Chung TN
• Chung HS
• Lee HS

Abstract

PURPOSE
The severity of a stroke cannot be described by widely used prehospital stroke scales. We investigated the usefulness of the Kurashiki Prehospital Stroke Scale (KPSS) for assessing the severity of stroke, compared to the National Institutes of Health Stroke Scale (NIHSS), in candidate patients for intravenous or intra-arterial thrombolysis who arrived at the hospital within 6 hours of symptom onset.
MATERIALS AND METHODS
We retrospectively analyzed a prospective registry database of consecutive patients included in the Emergency Stroke Therapy program. In the emergency department, the KPSS was assessed by emergency medical technicians. A cutoff KPSS score was estimated for candidates of thrombolysis by comparing KPSS and NIHSS scores, as well as for patients who actually received thrombolytic therapy. Clinical outcomes were compared between patients around the estimated cut-off. The independent predictors of outcomes were determined using multivariate logistic regression analysis.
RESULTS
Excellent correlations were demonstrated between KPSS and NIHSS within 6 hours (R=0.869) and 3 hours (R=0.879) of hospital admission. The optimal threshold value was a score of 3 on the KPSS in patients within 3 hours and 6 hours by Youden's methods. Significant associations with a KPSS score > or =3 were revealed for actual intravenous administration of tissue plasminogen activator (IV-tPA) usage [odds ratio (OR) 125.598; 95% confidence interval (CI) 16.443-959.368, p<0.0001] and actual IV-tPA or intra-arterial urokinase (IA-UK) usage (OR 58.733; 95% CI 17.272-199.721, p<0.0001).
CONCLUSION
The KPSS is an effective prehospital stroke scale for identifying candidates for IV-tPA and IA-UK, as indicated by excellent correlation with the NIHSS, in the assessment of stroke severity in acute ischemic stroke.

Keyword

Prehospital emergency care; stroke; thrombolytic therapy

MeSH Terms

Administration, Intravenous
Confidence Intervals
Emergencies
Emergency Medical Services
Emergency Medical Technicians
Emergency Service, Hospital
Humans
Logistic Models
Methods
National Institutes of Health (U.S.)
Prospective Studies
Retrospective Studies
Stroke*
Thrombolytic Therapy
Tissue Plasminogen Activator
Urokinase-Type Plasminogen Activator
Weights and Measures
Tissue Plasminogen Activator
Urokinase-Type Plasminogen Activator

Figure

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  Fig. 1 Enrollment and clinical outcomes. BEST, Brain Salvage through Emergency Stroke Therapy; IV-tPA, intravenous administration of tissue plasminogen activator; IA-UK, intra-arterial urokinase; MR, magnetic resonance; AMI, acute myocardial infarction.

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  Fig. 2 An excellent correlation was demonstrated between KPSS and NIHSS within 6 hours (A) [R=0.869; 95% CI (0.837-0.895), p<0.0001] and 3 hours (B) [R=0.879; 95% CI (0.840-0.907), p<0.0001] before admission. KPSS, Kurashiki Prehospital Stroke Scale; NIHSS, National Institutes of Health Stroke Scale.

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  Fig. 3 Kurashiki Prehospital Stroke Scale. Adapted from Iguchi, et al. Cerebrovase Dis 2011;31:51-6 with permission from S. Karger AG. Basel.3

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