(Stroke. 2000;31:71.)
© 2000 American Heart Association, Inc.
Original Contributions |
Identifying Stroke in the Field
Prospective Validation of the Los Angeles Prehospital Stroke Screen (LAPSS)
From the University of California at Los Angeles Stroke Center (C.S.K., S.S., J.L.S.); Departments of Neurology (C.S.K., S.S., J.L.S.) and Emergency Medicine (S.S.), University of California at Los Angeles Medical Center; Department of Emergency Medicine, University of Southern California (M.E., K.W.); and Los Angeles City Fire Department (M.E.).
Correspondence to Chelsea S. Kidwell, MD, Department of Neurology, UCLA Medical Center, Reed NRC, 710 Westwood Plaza, Los Angeles, CA 90095. E-mail ckidwell{at}ucla.edu
Background and Purpose—Reliable identification of stroke patients in the field by prehospital personnel could expedite delivery of acute stroke therapy. The Los Angeles Prehospital Stroke Screen (LAPSS) is a 1-page instrument designed to allow prehospital personnel to rapidly identify acute stroke patients in the field. We performed a prospective, in-the-field validation study of the LAPSS.
Methods—Paramedics assigned to 3 University of California at Los Angeles–based advanced life support units were trained and certified in use of the LAPSS. Over 7 months, paramedics completed the LAPSS on noncomatose, nontrauma patients with complaints suggestive of neurological disease. LAPSS form stroke identification results were compared with emergency department and final hospital discharge diagnoses. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and likelihood ratios were calculated for LAPSS identification of ischemic stroke, currently symptomatic transient ischemic attack, and intracerebral hemorrhage.
Results—Of a total of 1298 runs, 34% were for nontraumatic, noncomatose neurologically relevant complaints. Thirty-six of these patients (3% of all transports) had a final diagnosis of acute symptomatic cerebrovascular disease (21 ischemic strokes, 7 transient ischemic attacks, and 8 intracerebral hemorrhages). LAPSS forms were completed on 206 patients. Paramedic performance when completing the LAPSS demonstrated sensitivity of 91% (95% CI, 76% to 98%), specificity of 97% (95% CI, 93% to 99%), positive predictive value of 86% (95% CI, 70% to 95%), and negative predictive value of 98% (95% CI, 95% to 99%). With correction for the 4 documentation errors, positive predictive value increased to 97% (95% CI, 84% to 99%).
Conclusions—The LAPSS allows prehospital personnel to identify patients with acute cerebral ischemia and intracerebral hemorrhage with a high degree of sensitivity and specificity.
Key Words: emergency medical services • stroke, acute • stroke assessment
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