External Validation of the Cincinnati Prehospital Stroke Severity Scale.

TitleExternal Validation of the Cincinnati Prehospital Stroke Severity Scale.
Publication TypeJournal Article
Year of Publication2016
AuthorsKummer BR, Gialdini G, Sevush JL, Kamel H, Patsalides A, Navi BB
JournalJ Stroke Cerebrovasc Dis
Date Published2016 May
KeywordsAged, Aged, 80 and over, Brain Ischemia, Consciousness, Decision Support Techniques, Disability Evaluation, Emergency Medical Services, Eye Movements, Female, Health Status, Humans, Male, Middle Aged, Muscle Strength, Muscle, Skeletal, Predictive Value of Tests, Prognosis, Registries, Reproducibility of Results, Retrospective Studies, Severity of Illness Index, Stroke, Tertiary Care Centers, Upper Extremity

BACKGROUND: The Cincinnati Prehospital Stroke Severity Scale (CPSSS) was recently developed to predict large-vessel occlusions (LVOs) in patients with acute ischemic stroke (AIS). In its derivation study, which consisted of patients enrolled in thrombolysis and endovascular therapy trials, the CPSSS had excellent discriminatory performance. We sought to externally validate the CPSSS in an independent cohort.

METHODS: Using our institution's prospective stroke registry, we calculated CPSSS scores for all patients diagnosed with AIS at Weill Cornell Medical Center in 2013 and 2014. The primary outcome was presence of LVO and the secondary outcome was a National Institutes of Health Stroke Scale (NIHSS) score of 15 or higher. Harrell's c-statistic was calculated to determine the CPSSS score's discriminatory performance. Using the previously defined cut-point of 2 or higher (range 0-4), we evaluated the test properties of the CPSSS for predicting study outcomes.

RESULTS: Among 751 patients with AIS, 664 had vessel imaging and were included in the final analysis. Of these patients, 80 (14.2%) had LVOs and 117 (17.6%) had an NIHSS score of 15 or higher. The median CPSSS score was 0 (interquartile range 0-1) and 133 patients (20%) had scores of 2 or higher. c-statistic was .85 (95% confidence interval [CI] .81-.90) for predicting LVO and .94 (95% CI .92-.97) for predicting an NIHSS score of 15 or higher. Using a cut-point of 2 or higher, the CPSSS was 70.0% sensitive and 86.8% specific for predicting LVO, and 87.2% sensitive and 94.3% specific for predicting an NIHSS score of 15 or higher.

CONCLUSIONS: In a cohort of patients with AIS treated at a tertiary-care stroke center, the CPSSS had reasonable sensitivity and specificity for predicting LVO and severe stroke. Future studies should aim to prospectively validate the score in emergency responders.

Alternate JournalJ Stroke Cerebrovasc Dis
PubMed ID26971037
PubMed Central IDPMC5293409
Grant ListK23 NS091395 / NS / NINDS NIH HHS / United States
K23NS091395 / NS / NINDS NIH HHS / United States