Lack of Impact of Paramedic Training and Use of the Cincinnati Prehospital Stroke Scale on Stroke Patient Identification and On-Scene Time

Abstract

Background and Purpose— The Cincinnati Prehospital Stroke Scale (CPSS) is recommended for emergency medical services use in identifying patients with stroke. Data evaluating its performance in the field are limited. We assessed the impact of training and use of the CPSS on the accuracy of paramedics’ stroke patient identification and on-scene time. Methods— A 1-hour interactive educational presentation on the use of the CPSS was conducted for paramedics transporting patients to an academic medical center. Patients with stroke/transient ischemic attack (TIA) were identified retrospectively from paramedic records and were compared with the hospital’s prospective stroke registry for the year before and after the training. Results— There were 154 patients with suspected stroke/transient ischemic attack identified (56% women, 53% white, 44% black, mean age 67±16 years). There was no difference in paramedics’ use of the CPSS (37.5% versus 23.8%, P =0.123) or accuracy of stroke/TIA patient identification (40.5% versus 38.9%, P =0.859) before and after training. Of responsive patients identified by paramedics as having a stroke/TIA, 57% had an abnormality in at least one CPSS item with no effect on on-scene time (17±6 minutes with a normal versus 18±6 minutes with an abnormal CPSS, P =0.492). Those with a final diagnosis of stroke/TIA (n=61, 40%) more frequently had at least one abnormal CPSS item (70% versus 30%, P =0.008, sensitivity 0.71, specificity 0.52) with 49% of patients with an abnormality having a discharge diagnosis of stroke/TIA. Conclusions— Paramedic training in the CPSS, or its use, had no impact on the accuracy of their identification of patients with stroke/TIA or on-scene time.