Utility of the Kurashiki Prehospital Stroke Scale for hyperacute stroke.
BACKGROUND
Our aim was to confirm the utility of paramedics using the Kurashiki Prehospital Stroke Scale (KPSS), with a maximum score of 13, for patients who may be eligible for administration of intravenous tissue plasminogen activator (IV t-PA).


METHODS
The subjects comprised acute stroke and transient ischemic attack (TIA) patients transferred to our hospital by paramedics. We analyzed correlations between KPSS and the National Institutes of Health Stroke Scale (NIHSS). Patients admitted within 3 h of onset were categorized into 2 groups: KPSS ≥4 and KPSS <4. We compared the proportion of patients receiving IV t-PA between the groups.


RESULTS
Among 430 consecutive patients (mean age = 73 years; 266 men), paramedics recorded KPSS for 256 patients (59.5%). Excellent correlation was observed between KPSS and NIHSS in all 256 patients (R = 0.766; p < 0.001) and in 94 patients (ischemic stroke and TIA with symptoms on admission) admitted within 3 h of onset (R = 0.706; p < 0.001). Among these 94 patients, IV t-PA was more frequently given in the KPSS ≥4 group (30 of 58 patients, 51.7%) than in the KPSS <4 group (5 of 36 patients, 13.9%; p < 0.001). Arterial occlusion was more frequently observed in the KPSS ≥4 group (57.9 vs. 31.4%, p = 0.018). KPSS ≥4 was independently associated with administration of IV t-PA (odds ratio = 4.7; 95% confidence interval = 1.5-14.6, p = 0.008).


CONCLUSIONS
Reliable concordance between KPSS and NIHSS was found in acute stroke and TIA patients. KPSS ≥4 represents a good score to indicate prospective t-PA patients among those admitted within 3 h of stroke onset.
Iguchi
Yasuyuki
Y
Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki-City, Okayama, Japan. yigu@med.kawasaki-m.ac.jp
Kimura
Kazumi
K
Watanabe
Masao
M
Shibazaki
Kensaku
K
Aoki
Junya
J
D000368:Aged; D000369:Aged, 80 and over; D003243:Consciousness; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D007564:Japan; D007802:Language; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010343:Patient Admission; D018579:Patient Selection; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator