Cincinnati Prehospital Stroke Scale

Rapid stroke screening in prehospital setting

strokeneurologyA

Early identification of suspected stroke

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Test 1: Facial Symmetry (ask to smile)*

Ask the patient to show their teeth or smile

Normal - Both sides move equallyABNORMAL - One side does not move well

Test 2: Arm Drift (raise arms with eyes closed)*

Patient with eyes closed extends arms at 90° for 10 seconds

Normal - Both arms move equally or neither movesABNORMAL - One arm falls or drifts down

Test 3: Speech (repeat phrase)*

Ask to repeat: "You can't teach an old dog new tricks"

Normal - Words are clear and correctABNORMAL - Words are slurred, wrong, or unable to speak

Symptom Onset Time*

Time elapsed since symptom onset - critical for thrombolysis decision

Fields completed: 0 / 4

✅ Sensitivity 59%, Specificity 89% for stroke
✅ If even ONLY 1 test abnormal: 72% probability of stroke
⏱️ THERAPEUTIC WINDOWS FOR ISCHEMIC STROKE:
• 0-3h: IV Thrombolysis (alteplase) - OPTIMAL window
• 3-4.5h: IV Thrombolysis (alteplase) - EXTENDED window (selected criteria)
• 0-6h: Mechanical thrombectomy - STANDARD with LVO (large vessel occlusion)
• 6-16h: Mechanical thrombectomy - INDICATED with favorable imaging
• 16-24h: Mechanical thrombectomy - REASONABLE (DAWN/DEFUSE-3 trials)
🔴 CRITICAL: Document LAST KNOWN WELL time (when seen normal last) - NOT time of 118 call
🚁 Consider helicopter transport if >30 min from stroke center
📞 Pre-alert hospital with Glasgow, glucose, BP, last meal