Understanding Stroke Exams: Identifying and Assessing Stroke Quickly and Effectively

The FAST Acronym: Recognizing Stroke Symptoms Quickly

The FAST acronym is a simple and effective way to identify potential stroke symptoms, often used by the general public and first responders:

• Face: Does one side of the face droop when the person smiles?
• Arms: Can the person lift both arms, or does one drift downward?
• Speech: Is their speech slurred, or do they have trouble speaking or understanding?
• Time: If you notice any of these symptoms, it’s time to call 911 immediately.

FAST is not a comprehensive assessment but provides a quick way to recognize warning signs and seek emergency care.

Cincinnati Prehospital Stroke Scale (CPSS)

The Cincinnati Prehospital Stroke Scale is a simple tool used by EMS providers to quickly evaluate for stroke. It focuses on three primary physical signs:

1. Facial Droop: Ask the patient to smile or show their teeth.some text
   • Normal: Both sides of the face move equally.
   • Abnormal: One side of the face does not move.
2. Arm Drift: Ask the patient to hold both arms out in front of them with their eyes closed.some text
   • Normal: Both arms remain steady.
   • Abnormal: One arm drifts downward.
3. Speech: Ask the patient to repeat a simple phrase, such as "The sky is blue."some text
   • Normal: Speech is clear and correct.
   • Abnormal: Speech is slurred or incorrect.

The CPSS is widely used in the field because it is quick, easy, and effective for identifying stroke symptoms. If one or more of these signs are present, it increases the likelihood of stroke and signals the need for immediate transport to a hospital.

National Institutes of Health Stroke Scale (NIHSS)

The NIH Stroke Scale (NIHSS) is the gold standard for evaluating stroke severity. It is a detailed, 15-item assessment used in hospitals and research settings. The NIHSS evaluates several aspects of brain function, including consciousness, vision, sensation, movement, speech, and language.

Each item is scored on a scale, and the total score helps determine the severity of the stroke:

• 0: No symptoms.
• 1-4: Minor stroke.
• 5-15: Moderate stroke.
• 16-20: Moderate to severe stroke.
• 21-42: Severe stroke.

The NIHSS takes longer to perform than the CPSS, but its comprehensive nature makes it invaluable for guiding treatment decisions, such as whether to administer clot-busting drugs or consider advanced interventions like thrombectomy.

Los Angeles Prehospital Stroke Screen (LAPSS)

The LAPSS is another prehospital tool that adds a few extra steps to ensure accuracy. It evaluates:

• Facial droop, arm drift, and speech, similar to CPSS.
• Blood glucose levels to rule out hypoglycemia.
• The patient’s age and history of seizures or strokes.

The LAPSS is less commonly used than CPSS but provides a more detailed initial assessment in certain cases.

Rapid Arterial Occlusion Evaluation (RACE) Scale

The RACE Scale is designed to identify large vessel occlusions (LVOs), which are severe strokes requiring advanced treatments like thrombectomy. It evaluates:

• Facial palsy.
• Arm and leg motor function.
• Gaze deviation.
• Aphasia (language impairment) or agnosia (inability to recognize objects).

RACE is typically used in the field to prioritize transport to a comprehensive stroke center capable of advanced care.

When and Where These Tools Are Used

• FAST: Simple and accessible for the general public to recognize stroke symptoms.
• Cincinnati Prehospital Stroke Scale (CPSS): Quick, reliable, and widely used by EMS providers.
• NIHSS: Comprehensive and used primarily in hospitals for severity assessment and treatment planning.
• LAPSS and RACE: Prehospital tools for more specific or advanced cases, depending on the situation.

How STROK3 Enhances Stroke Assessments

STROK3 builds on these established tools by enabling EMS providers to perform guided, video-based stroke assessments using scales like CPSS and NIHSS. The platform securely transmits these assessments, along with patient data, to hospital teams in real time. This allows for better preparation and faster decision-making, reducing the time to treatment and improving outcomes.

By standardizing and digitizing stroke assessments, STROK3 ensures accuracy and provides hospitals with the critical information they need before the patient arrives.

Conclusion

From the layman-friendly FAST acronym to detailed tools like NIHSS, stroke exams are essential for recognizing and managing strokes effectively. Each tool serves a specific purpose, and together they create a comprehensive system for identifying, assessing, and treating strokes. With innovations like STROK3, we’re taking these assessments to the next level, empowering first responders and hospitals to work together seamlessly to save lives.

For more information about STROK3 and how we’re improving stroke care, visit www.STROK3.com.

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