IV-14 Circulation December 13. 2005 TABLE 2. Los Angeles Prehospital Stroke Screen(LAPSS) For evaluation of acute, noncomatose, nontraumatic neurologic complaint If items 1 through 6 are all checked "Yes"(or " Unknown"), provide prearrival notification to hospital of potential stroke patient. If any item is checked"No retum to appropriate treatment protocol Interpretation: 93% of patients with stroke will have a positive LAPSS score(sensitivity=93%), and 97%of those with a positive LAPSS score will have a stroke(specificity =97%). Note that the patient may still be experiencing a stroke if LAPSS criteria Criteria Unknown 1. Age >45 years 2. History of seizures or epilepsy absent 3. Symptom duration <24 hours 4. At baseline, patient is not wheelchair bound or bedridden 5. Blood glucose between 60 and 400 口口口口口口 口口口口口口 6. Obvious asymmetry ( right vs left) in any of the following 3 exam categories Equal R Weak L Weak Facial smile/grimace 口 Droop 口口口 口 Weak grip 口 Weak grip 口 No grip 口 No grip Arm strength □ Drifts down 口 Drifts down 口 Falls rapidly 口 Falls rapidly One-sided motor weakness(night arm) dwell CS, Saver儿L, ert GB, Eckstein M, Starkman S Design and retrospective analysis of the Los Angeles prehospital stroke screen(LAPSS). Prehosp Emerg Care.1998;2:267-273 Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL. Identifying stroke in the field: prospective validation of the Los Angeles Prehospital Stroke Screen(LAPSS) Stke.200031:71-76 In-Hospital Care assessment and support of airway, breathing, and circulation Initial ED Assessment and Stabilization, delay to and evaluation of baseline vital signs. We recommend that Protocols should be used in the ed to minimi definitive diagnosis and therapy 28 As a goal, ED personnel providers administer oxygen to hypoxemic patients in the ED should assess the patient with suspected stroke within 10( Class I)and consider oxygen administration for patients minutes of arrival in the ED(Box 3). General care includes without hypoxemia( Class IIb)In-Hospital Care Initial ED Assessment and Stabilization Protocols should be used in the ED to minimize delay to definitive diagnosis and therapy.28 As a goal, ED personnel should assess the patient with suspected stroke within 10 minutes of arrival in the ED (Box 3). General care includes assessment and support of airway, breathing, and circulation and evaluation of baseline vital signs. We recommend that providers administer oxygen to hypoxemic patients in the ED (Class I) and consider oxygen administration for patients without hypoxemia (Class IIb). TABLE 2. Los Angeles Prehospital Stroke Screen (LAPSS) For evaluation of acute, noncomatose, nontraumatic neurologic complaint. If items 1 through 6 are all checked “Yes” (or “Unknown”), provide prearrival notification to hospital of potential stroke patient. If any item is checked “No,” return to appropriate treatment protocol. Interpretation: 93% of patients with stroke will have a positive LAPSS score (sensitivity93%), and 97% of those with a positive LAPSS score will have a stroke (specificity97%). Note that the patient may still be experiencing a stroke if LAPSS criteria are not met. Criteria Yes Unknown No 1. Age 45 years 2. History of seizures or epilepsy absent 3. Symptom duration
24 hours 4. At baseline, patient is not wheelchair bound or bedridden 5. Blood glucose between 60 and 400 6. Obvious asymmetry (right vs left) in any of the following 3 exam categories (must be unilateral): Equal R Weak L Weak Facial smile/grimace Droop Droop Grip Weak grip No grip Weak grip No grip Arm strength Drifts down Falls rapidly Drifts down Falls rapidly One-sided motor weakness (right arm). Kidwell CS, Saver JL, Schubert GB, Eckstein M, Starkman S. Design and retrospective analysis of the Los Angeles prehospital stroke screen (LAPSS). Prehosp Emerg Care. 1998;2:267–273. Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL. Identifying stroke in the field: prospective validation of the Los Angeles Prehospital Stroke Screen (LAPSS). Stroke. 2000;31:71–76. IV-114 Circulation December 13, 2005