How to test for stroke
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How to Test for Stroke: A Comprehensive Overview
Prehospital Stroke Scales for Early Identification
Cincinnati Prehospital Stroke Scale (CPSS)
The Cincinnati Prehospital Stroke Scale (CPSS) is widely used by paramedics to identify stroke symptoms in the field. It has been found to have the highest sensitivity among prehospital stroke scales, making it a preferred choice for initial stroke screening. CPSS evaluates facial droop, arm drift, and speech abnormalities, which are common indicators of stroke.
Los Angeles Prehospital Stroke Scale (LAPSS)
The Los Angeles Prehospital Stroke Scale (LAPSS) is another tool used in prehospital settings. It has shown a summary sensitivity of 0.83 and specificity of 0.93, although the validity of these results is uncertain due to potential biases in the studies. LAPSS includes criteria such as age, history of seizures, and blood glucose levels, in addition to the standard stroke symptoms.
Face Arm Speech Time (FAST)
The FAST scale is a simplified tool that assesses facial droop, arm weakness, and speech difficulties. It is often used in both prehospital and emergency room settings. Studies have shown that FAST has similar accuracy to the Recognition of Stroke in the Emergency Room (ROSIER) scale when used in the ER.
Emergency Room Stroke Scales
Recognition of Stroke in the Emergency Room (ROSIER)
The ROSIER scale is specifically designed for use in emergency rooms. It has demonstrated high sensitivity (0.88) for detecting strokes and transient ischemic attacks (TIAs) . The ROSIER scale includes assessments of facial weakness, arm weakness, leg weakness, speech disturbance, and visual field defects.
Comparison of ER Scales
In the emergency room, ROSIER is recommended over other scales like FAST due to its higher sensitivity and the larger number of studies supporting its use. However, the specificity of ROSIER varies depending on the setting and the assessor, with higher specificity observed when administered by physicians and neurologists.
Biochemical Markers for Stroke Diagnosis
Blood-Borne Biochemical Markers
Recent research has explored the use of blood-borne biochemical markers to diagnose acute cerebral ischemia. A panel including markers of glial activation (S100β), inflammation (matrix metalloproteinase-9 and vascular cell adhesion molecule), and thrombosis (von Willebrand factor) has shown promise. This panel achieved a sensitivity and specificity of 90% for predicting stroke, suggesting it could be a valuable tool for early stroke identification.
Functional Assessment Tools
Computerized Adaptive Testing Systems
Computerized adaptive testing systems like the CAT-FAS and CAT-5F have been developed to assess various functions in stroke patients, including upper and lower extremity motor function, postural control, and activities of daily living. These systems are efficient, requiring fewer items to administer while maintaining high reliability and validity .
Action Research Arm Test (ARAT)
The ARAT is a responsive and valid measure of upper-extremity function in stroke patients. It has been shown to be effective in acute rehabilitation settings, correlating well with other sensorimotor impairment measures and disability assessments.
Conclusion
Testing for stroke involves a combination of prehospital and emergency room scales, biochemical markers, and functional assessment tools. The CPSS is highly sensitive for field use, while the ROSIER scale is preferred in emergency rooms. Biochemical markers offer a promising avenue for early diagnosis, and computerized adaptive testing systems provide efficient and reliable functional assessments. These tools collectively enhance the accuracy and timeliness of stroke diagnosis, ultimately improving patient outcomes.
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