Cincinnati Prehospital Stroke Scale Calculator

How does this Cincinnati prehospital stroke scale calculator work?

This health assessment analyses the probability of a patient suffering from stroke, either before ER or during ER examination. It comprises of three areas of test and delivers the CVA risk percentage.

This Cincinnati prehospital stroke scale calculator is of use for medical specialists who wish to inspect patient reactions in order to evaluate facial palsy, arm weakness and speech abnormalities. Each criterion is described with the normal and abnormal reaction.

The abnormal reactions are assigned one point for each of the three criteria. At the end of the stroke assessment, the point result will be interpreted for the probability of CVA (cerebrovascular accident) present.

The Cincinnati Prehospital Stroke Scale (CPSS)

■ During the facial droop sequence, the patient may be asked to smile while the medical professional assesses the degree of symmetry in the facial movement or any unilateral disparity. The test is negative if the patient manages to smile, show teeth and the movement is equal in both sides. The test is positive if there is weakness present unilaterally or even one part of face doesn’t move at all.

■ During the arm drift or arm weakness test, the patient is asked to hold arms out in front of them for 10 seconds while keeping their eyes close. If the patient is able to hold arms symmetrically, regardless of strength or weakness exerted, this test is considered negative. If there is a drift to one side from the starting position, the test is deemed positive.

■ In the slurred speech test, the patient may be asked to repeat a simple sentence such as “you can't teach an old dog new tricks”. The professional observes whether the sentence is repeated correctly, negative result or the patient is unable to repeat the words correctly, intelligibly or there is no verbal response, in this case this sequence of the scale proving positive.

CPSS Interpretation

A score of 1 correlates with the probability of an ischemic stroke/ CVA in 72% of cases. With a score of 3, meaning 3 new findings, the probability of stroke being present increases to 85% of cases.

Other stroke symptoms

While suspected stroke algorithms such as the Cincinnati scale are increasingly being used in clinical practice in ER and allow a quick and early recognition of stroke symptoms, and also an active promotion of stroke awareness there are also other symptoms that could appear such as:

■ Complete paralysis of one side of the body;

■ Sudden blurring or loss of vision;

■ Confusion;

■ Dizzinees;

■ Difficulty interacting with others;

■ Balance and coordination impairement;

■ Headache of high intensity;

■ Loss of consciousness.

Stroke vs. transient ischemic attach

TIA and CVA have similar symptoms but the ones in TIA usually tend to last from a few minutes to a few hours before disappearing, while symptoms due to a cerebrovascular attack don’t improve in time and need a long term recovery, often the patient not regaining the entirety of the lost functions.

Transient attacks are a serious warning that there is a brain blood supply impairment and can predict/ increase the risk of suffering a future stroke if care is not provided.

References

1) Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. (1999) Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med; 33(4):373-8

2) Studnek JR, Asimos A, Dodds J, Swanson D. (2013) Assessing the validity of the Cincinnati prehospital stroke scale and the medic prehospital assessment for code stroke in an urban emergency medical services agency. Prehosp Emerg Care; 17(3):348-53.