ArticleCerebrovascular diseases (Basel, Switzerland)2026
Prehospital Validation of the Scale to Identify Large Vessel Occlusion in Suspected Stroke Patients.
Article in Cerebrovascular diseases (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionTimely identification and transfer of patients with large vessel occlusion (LVO) to thrombectomy-capable stroke centers (TSCs) for endovascular thrombectomy (EVT) remains a major challenge in prehospital stroke care. This study evaluated the clinimetric performance of the Cincinnati Prehospital Stroke Scale (CPSS), the Maria Prehospital Stroke Scale (MPSS) and novel LVO screening scales created by integrating four LVO-related items into these established prehospital assessments.
methodsUsing prehospital electronic records linked with hospital data across Kawasaki City from April 2023 to March 2024, we retrospectively analyzed whether the addition of aphasia, unilateral spatial neglect, conjugate eye deviation, and atrial fibrillation (via ambulance ECG) improved prehospital LVO detection. These items were incorporated into the MPSS (MPSS+4 scale) and CPSS (CPSS+4 scale), and the predictive performance of four tools: CPSS, CPSS+4 scale, MPSS, and MPSS+4 scale was compared.
resultsAmong 1,653 transported patients, 207 (12.5%) had LVO. MPSS+4 scale demonstrated the highest predictive performance for LVO (AUROC 0.768). The addition of the four LVO-related items significantly improved LVO prediction for both MPSS and CPSS (p < 0.001 for each). Higher MPSS+4 scale scores were strongly and progressively associated with the likelihood of receiving EVT after hospital arrival. Adjusted odds ratios increased from 2.97 to 100.59 for scores 2-9 compared with a score of 1.
conclusionIncorporating LVO-related items into prehospital stroke assessment substantially improved diagnostic precision for LVO, with MPSS+4 scale outperforming all other tools. The strong association between MPSS+4 scale scores and subsequent EVT implementation suggests that MPSS+4 scale may serve as a practical, clinically meaningful instrument for emergency medical technicians in prehospital triage of suspected acute stroke and identification of EVT candidates.
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