Ability of laypersons to use the cincinnati prehospital stroke scale

Objective

Early stroke recognition optimizes patients' opportunities to benefit from therapeutic options. Prehospital stroke recognition is suboptimal. If 9-1-1 dispatchers used stroke-identification tools, prehospital stroke recognition might occur more rapidly and accurately. The Cincinnati Prehospital Stroke Scale (CPSS) is a brief, effective tool used by emergency medical services and hospital personnel to identify stroke. The study's goal was to determine whether laypersons could be instructed to use the CPSS over the telephone.

Methods

Adult visitors (laypersons) to a tertiary care emergency department were enrolled. Using a mock patient, laypersons were instructed to use the CPSS via telephone by an investigator simulating a 9-1-1 dispatcher. The patient randomly portrayed clinically normal and abnormal patient types. The layperson's ability to convey CPSS instructions to the patient and relay findings to the investigator was scored.

Results

Seventy laypersons were enrolled (35 each for normal and abnormal patient types). Average age was 48 years, 63% were female, and 40% never attended college. Facial droop and speech instructions were administered with 100% accuracy. Arm drift instructions were administered with 99% accuracy. Layperson accuracies for interpreting findings were 93% for facial droop, 93% for arm drift, and 97% for speech. Overall, stroke symptoms were detected with 94% sensitivity (95% CI 87, 100) and 83% specificity (95% CI 70, 95).

Conclusion

Laypersons correctly administered and interpreted the CPSS when directed to do so over the telephone by a trained investigator. These findings suggest that the CPSS may be a useful tool in early prehospital detection of stroke by dispatchers.