Components Of The Cincinnati Prehospital Stroke Scale

2 min read 28-11-2024

Components Of The Cincinnati Prehospital Stroke Scale

The Cincinnati Prehospital Stroke Scale (CPSS) is a rapid, easy-to-use neurological assessment tool employed by emergency medical services (EMS) personnel to preliminarily screen patients for potential stroke. It's crucial to remember that the CPSS is a screening tool, not a definitive diagnostic test. A positive CPSS score strongly suggests the need for further, more comprehensive evaluation in a hospital setting. A negative score does not rule out a stroke.

The Three Components

The CPSS focuses on three key neurological functions:

1. Facial Droop

This assesses facial symmetry. The patient is asked to smile. A positive finding is indicated by asymmetry of the facial muscles, such as one side of the mouth drooping or being unable to fully raise.

2. Arm Drift

This tests for upper extremity weakness. The patient is asked to close their eyes and extend both arms forward with palms facing upwards. A positive finding is observed if one arm drifts downward or pronates (turns palm downwards).

3. Speech

This evaluates the ability to speak clearly and articulate words. The patient is asked to repeat a simple phrase, such as "The sky is clear." A positive finding includes slurred speech, difficulty articulating words, or inability to repeat the phrase correctly.

Interpreting the Results

Each component receives a score of either positive (+) or negative (-).

Positive score on any of the three components indicates a positive CPSS. This warrants immediate transport to a stroke center for further evaluation.
Negative scores on all three components suggests a lower likelihood of stroke, but doesn't rule it out. EMS personnel should still consider other potential causes of symptoms and utilize their clinical judgment in determining appropriate treatment.

Limitations of the CPSS

It's crucial to understand the limitations of the CPSS:

Sensitivity and Specificity: While relatively easy to administer, the CPSS has limitations in sensitivity and specificity. It may miss some strokes (false negative) and incorrectly identify non-stroke conditions as stroke (false positive).
Subjectivity: The interpretation of the CPSS can be subjective, depending on the skill and experience of the EMS personnel performing the assessment.
Not a Diagnostic Tool: The CPSS is a screening tool only. It cannot replace a comprehensive neurological examination and advanced imaging studies (such as CT scan or MRI) in diagnosing stroke.

In conclusion, the CPSS is a valuable tool for EMS providers in the prehospital setting to identify patients who may be experiencing a stroke. However, it is crucial to remember its limitations and that a positive or negative CPSS does not definitively diagnose or rule out a stroke. Prompt transport to an appropriate medical facility for definitive diagnosis and treatment remains paramount.