Cincinnati Prehospital Stroke Severity Scale (CP-SSS)
Predicts large vessel occlusion (LVO) and severe stroke in patients with stroke symptoms.
Use in a hospital setting in patients with signs and symptoms of acute ischemic stroke.
Advice
- Neurological consultation should be obtained immediately in suspected acute ischemic stroke.
- Acute ischemic stroke is a neurological emergency that is amenable to time-sensitive treatments (e.g. tPA, mechanical thrombectomy) if certain clinical conditions are met.
- Should not be used as a substitute for clinical judgment, and is intended for use as an adjunct to medical decision-making.
Management
- In cases of suspected acute ischemic stroke from LVO, the following is recommended:
- STAT neurological consultation.
- STAT CT head without contrast.
- STAT CTA head and neck with contrast.
- STAT laboratory testing (complete blood count, coagulation profile, basic metabolic panel, type and screen, troponin-I).
Critical Actions
- Intravenous tissue plasminogen activator (IV tPA) is the standard-of-care treatment for adult patients presenting with acute ischemic stroke within 4.5 hours of symptom onset if no exclusion criteria are met, irrespective of whether LVO is the cause or not.
- Endovascular (mechanical) thrombectomy is the standard-of-care treatment for selected adult patients presenting with acute ischemic stroke due to LVO.
- A patient’s appropriateness for endovascular intervention depends on multiple factors, such as time since onset of symptoms, neuroimaging, baseline functional status, and others.
- Appropriateness for intravenous thrombolysis or mechanical thrombectomy should be determined by neurological/neurosurgical consultant whenever available.