Los Angeles Prehospital Stroke Screen (LAPSS)
The Los Angeles Prehospital Stroke Screen is a method of identifying potential stroke victims in a pre-hospital setting. The system includes the Cincinnati Prehospital Stroke Scale in addition to age criteria, blood glucose criteria and several other factors.[1]
Use
The screening criteria are as follows:
| Yes | No | |
|---|---|---|
| Age over 45 | ||
| No prior history of seizure disorder | ||
| New onset of neurologic symptoms in the last 24 hours | ||
| Patient was ambulatory at baseline (prior to event)? | ||
| Blood glucose between 60 and 400 | ||
| Obvious Asymmetry |
| Normal | Right | Left | |
|---|---|---|---|
| Facial Droop | |||
| Grip | |||
| Arm weakness | |||
| Yes | No | |
|---|---|---|
| Based on exam, patient has only unilateral (and not bilateral) weakness. | ||
| If yes (or unknown) to all items above LAPSS screening criteria met: | ||
If LAPSS criteria for stoke met, call receiving hospital with "STROKE CODE", if not then return to the appropriate treatment protocol. (Note: The patient may still be experiencing a stroke even if LAPSS criteria are not met.[2]
Validity
A January 2000 study, conducted by 3 teams of Los Angeles-based paramedic units resulted in "sensitivity of 91% (95% CI, 76% to 98%), specificity of 97% (95% CI, 93% to 99%), positive predictive value of 86% (95% CI, 70% to 95%), and negative predictive value of 98% (95% CI, 95% to 99%). With correction for the 4 documentation errors, positive predictive value increased to 97% (95% CI, 84% to 99%)."[3]
In a Chinese study, Beijing paramedics using the protocol, completed LAPSS screenings in an average of 4.3 minutes. The study resulted in a sensitivity of 78.44% and a specificity of 90.22%.[4] The average time of completing the LAPSS was 4.3±3.0 minutes (median, 5 minutes). The sensitivity and specificity of the LAPSS in this study was 78.44% and 90.22%.
References
- ↑ American Heart Association - Stroke
- ↑ LAPSS Protocol
- ↑ "Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS).". US National Library of Medicine National Institutes of Health. 31 Jan 2000. Retrieved 3 February 2014.
- ↑ "Validation of the Los Angeles pre-hospital stroke screen (LAPSS) in a Chinese urban emergency medical service population.". US National Library of Medicine National Institutes of Health. 2013-08-07. Retrieved 3 February 2014.