Stroke Scale

Cincinnati Prehospital Stroke Scale

  • The Cincinnati Prehospital Stroke Scale helps to identify strokes using the FAST mnemonic.

    • F (Facial Droop): Observe if one side of the face droops when asked to smile or show teeth.

    • A (Arm Drift): Ask the patient to close their eyes and hold both arms out for 10 seconds. A drop indicates a positive test.

    • S (Speech Abnormality): Listen for slurred speech or difficulty in speech production.

    • T (Time): Document the last time the patient was seen normal; crucial for treatment timing.

  • BEFAST is a variation that includes:

    • B (Balance): Assess for balance issues.

    • E (Eyes): Look for nystagmus or asymmetric pupils during exam.

  • BEFAST is preferred by some as it provides additional information.

Los Angeles Prehospital Stroke Scale

  • A separate and detailed scoring system from the Cincinnati scale.

  • Comprised of six questions and three physical examinations to identify a stroke.

    • Each 'yes' answer contributes to a positive score indicating stroke likelihood.

  • A score of five 'yes' or 'unknown' responses shows a 97% chance of a stroke.

Scoring Criteria

  1. Age above 45: Selct 'yes' for patients older than 45.

  2. No History of Seizures: Positive response for no history of seizures.

  3. Symptoms Occurred Within 24 Hours: Symptoms must be new and acute.

  4. Not Bed/ Wheelchair Bound: Patient can move independently; not dependent on assistive devices.

  5. Blood Glucose Level Check: Critical to check blood glucose to rule out hypoglycemia, which can mimic stroke symptoms.

  6. Objective Signs of Asymmetry: Perform three exams:

    • Facial Droop Test: Similar to the Cincinnati test.

    • Grip Strength: Assess strength in both hands.

    • Arm Strength Test: Evaluate if arms drift down or drop.

  • The Los Angeles scale empowers responders to potentially classify a stroke even with unknown history or results, aligning with treatment protocols.