title: The usefulness of the Kurashiki prehospital stroke scale in identifying thrombolytic candidates in acute ischemic stroke.
abstract: OBJECTIVE
  The severity of a stroke cannot be described by widely used prehospital stroke scales. We investigated the usefulness of the Kurashiki Prehospital Stroke Scale (KPSS) for assessing the severity of stroke, compared to the National Institutes of Health Stroke Scale (NIHSS), in candidate patients for intravenous or intra-arterial thrombolysis who arrived at the hospital within 6 hours of symptom onset.
  
  
  METHODS
  We retrospectively analyzed a prospective registry database of consecutive patients included in the Emergency Stroke Therapy program. In the emergency department, the KPSS was assessed by emergency medical technicians. A cutoff KPSS score was estimated for candidates of thrombolysis by comparing KPSS and NIHSS scores, as well as for patients who actually received thrombolytic therapy. Clinical outcomes were compared between patients around the estimated cut-off. The independent predictors of outcomes were determined using multivariate logistic regression analysis.
  
  
  RESULTS
  Excellent correlations were demonstrated between KPSS and NIHSS within 6 hours (R=0.869) and 3 hours (R=0.879) of hospital admission. The optimal threshold value was a score of 3 on the KPSS in patients within 3 hours and 6 hours by Youden's methods. Significant associations with a KPSS score≥3 were revealed for actual intravenous administration of tissue plasminogen activator (IV-tPA) usage [odds ratio (OR) 125.598; 95% confidence interval (CI) 16.443-959.368, p<0.0001] and actual IV-tPA or intra-arterial urokinase (IA-UK) usage (OR 58.733; 95% CI 17.272-199.721, p<0.0001).
  
  
  CONCLUSIONS
  The KPSS is an effective prehospital stroke scale for identifying candidates for IV-tPA and IA-UK, as indicated by excellent correlation with the NIHSS, in the assessment of stroke severity in acute ischemic stroke.
authors.affiliation: Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. youjsmd@yuhs.ac.
authors.forename: Jieun
authors.initials: J
authors.lastname: Jang
authors.forename: Sung Phil
authors.initials: SP
authors.lastname: Chung
authors.forename: Incheol
authors.initials: I
authors.lastname: Park
authors.forename: Je Sung
authors.initials: JS
authors.lastname: You
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.forename: Jong Woo
authors.initials: JW
authors.lastname: Park
authors.forename: Tae Nyoung
authors.initials: TN
authors.lastname: Chung
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Chung
authors.forename: Hahn Shick
authors.initials: HS
authors.lastname: Lee
mesh_terms: D006801:Humans; D020521:Stroke / Q000175:diagnosis*
keywords: Prehospital emergency care; stroke; thrombolytic therapy