title: Design and validation of a prehospital scale to predict stroke severity: Cincinnati Prehospital Stroke Severity Scale.
abstract: OBJECTIVE
  We derived and validated the Cincinnati Prehospital Stroke Severity Scale (CPSSS) to identify patients with severe strokes and large vessel occlusion (LVO).
  
  
  METHODS
  CPSSS was developed with regression tree analysis, objectivity, anticipated ease in administration by emergency medical services personnel and the presence of cortical signs. We derived and validated the tool using the 2 National Institute of Neurological Disorders and Stroke (NINDS) tissue-type plasminogen activator Stroke Study trials and Interventional Management of Stroke III (IMS III) Trial cohorts, respectively, to predict severe stroke (National Institutes of Health Stroke Scale [NIHSS]≥15) and LVO. Standard test characteristics were determined and receiver operator curves were generated and summarized by the area under the curve.
  
  
  RESULTS
  CPSSS score ranges from 0 to 4; composed and scored by individual NIHSS items: 2 points for presence of conjugate gaze (NIHSS≥1); 1 point for presence of arm weakness (NIHSS≥2); and 1 point for presence abnormal level of consciousness commands and questions (NIHSS level of consciousness≥1 each). In the derivation set, CPSSS had an area under the curve of 0.89; score≥2 was 89% sensitive and 73% specific in identifying NIHSS≥15. Validation results were similar with an area under the curve of 0.83; score≥2 was 92% sensitive, 51% specific, a positive likelihood ratio of 3.3, and a negative likelihood ratio of 0.15 in predicting severe stroke. For 222 of 303 IMS III subjects with LVO, CPSSS had an area under the curve of 0.67; a score≥2 was 83% sensitive, 40% specific, positive likelihood ratio of 1.4, and negative likelihood ratio of 0.4 in predicting LVO.
  
  
  CONCLUSIONS
  CPSSS can identify stroke patients with NIHSS≥15 and LVO. Prospective prehospital validation is warranted.
authors.affiliation: From the Department of Neurology (B.S.K., J.P.B.) and Department of Emergency Medicine (J.T.M., O.A.), University of Cincinnati, College of Medicine, OH; and Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.). katzbs@ucmail.uc.edu.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Katz
authors.affiliation: From the Department of Neurology (B.S.K., J.P.B.) and Department of Emergency Medicine (J.T.M., O.A.), University of Cincinnati, College of Medicine, OH; and Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.).
authors.forename: Jason T
authors.initials: JT
authors.lastname: McMullan
authors.affiliation: From the Department of Neurology (B.S.K., J.P.B.) and Department of Emergency Medicine (J.T.M., O.A.), University of Cincinnati, College of Medicine, OH; and Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.).
authors.forename: Heidi
authors.initials: H
authors.lastname: Sucharew
authors.affiliation: From the Department of Neurology (B.S.K., J.P.B.) and Department of Emergency Medicine (J.T.M., O.A.), University of Cincinnati, College of Medicine, OH; and Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.).
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
authors.affiliation: From the Department of Neurology (B.S.K., J.P.B.) and Department of Emergency Medicine (J.T.M., O.A.), University of Cincinnati, College of Medicine, OH; and Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.).
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
mesh_terms: D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D055825:National Institute of Neurological Disorders and Stroke (U.S.); D009820:Ohio; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: NIHSS; acute stroke; prehospital emergency care; severe stroke; vessel occlusion