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Tests 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 in the field for the early identification of stroke. It has consistently shown the highest sensitivity among various prehospital stroke scales, making it a preferred choice for paramedics and emergency medical services (EMS). 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 a summary sensitivity of 0.83 and a specificity of 0.93, indicating its reliability in identifying stroke cases. However, the validity of these results is uncertain due to potential biases in the studies reviewed.

Face Arm Speech Time (FAST)

The FAST scale is a simple and quick tool used both in prehospital and emergency room settings. It has shown similar accuracy to the ROSIER scale when used in the emergency room. FAST is particularly useful for its ease of use and rapid assessment capabilities.

Recognition of Stroke in the Emergency Room (ROSIER)

The ROSIER scale is highly effective in emergency room settings, with a sensitivity of 0.88. It is recommended as the test of choice in the ER due to its consistent high sensitivity across multiple studies . ROSIER evaluates factors such as facial weakness, arm weakness, and speech disturbance, along with other neurological signs.

Biomarker-Based Diagnostic Tests

Blood-Borne Biochemical Markers

Recent studies have explored the feasibility of using blood-borne biochemical markers for the diagnosis of acute stroke. Markers such as S100β, matrix metalloproteinase-9, vascular cell adhesion molecule, and von Willebrand factor have shown high correlation with stroke, providing a sensitivity and specificity of 90% in predicting stroke. These markers can be particularly useful in prehospital settings to fast-track patients to specialized care.

Biomarker Rapid Assessment in Ischemic Injury (BRAIN) Study

The BRAIN study assessed a panel of biomarkers including matrix metalloproteinase 9, brain natriuretic factor, d-dimer, and S-100β. This panel demonstrated a sensitivity of 86% for detecting all strokes and 94% for hemorrhagic strokes, suggesting its potential utility in early stroke diagnosis. The study highlights the feasibility of using a point-of-care platform for rapid stroke identification.

Functional Assessment Tests Post-Stroke

Action Research Arm Test (ARAT)

The ARAT is a valid and responsive measure for assessing upper-extremity function in stroke patients. It has shown high responsiveness and validity in detecting changes in motor function over time, making it suitable for use in acute rehabilitation trials.

Six-Minute Walk Test (6MWT)

The 6MWT is a reliable measure of functional capacity in stroke patients, with a high test-retest reliability (ICC of 0.98). However, further research is needed to explore other types of reliability and standard error measurements.

Wolf Motor Function Test (WMFT)

The WMFT is used to describe the functional abilities of stroke patients with moderate to severe hemiparesis. A new calculation method using the mean rate of performance has shown to be more sensitive and valid in describing functional activities compared to the traditional median performance times.

Conclusion

In summary, various tests and scales are available for the early identification and functional assessment of stroke. The CPSS and ROSIER scales are highly recommended for prehospital and emergency room settings, respectively, due to their high sensitivity. Biomarker-based diagnostic tests show promise for rapid and accurate stroke identification. Functional assessment tools like ARAT, 6MWT, and WMFT are essential for evaluating motor impairments and guiding rehabilitation efforts post-stroke. Further research and validation are needed to enhance the accuracy and reliability of these diagnostic and assessment tools.