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Stroke Journal Report
02/18/2003

Just a minute: Bystanders may identify stroke symptoms in 60 seconds

PHOENIX, Feb. 13 – A bystander may be able to spot someone having a stroke by giving the person a simple, quick test to see if they can smile, raise both arms and keep them up, and speak a simple sentence coherently, according to a report presented today at the American Stroke Association’s 28th International Stroke Conference.  The American Stroke Association is a division of the American Heart Association.

      The test, which takes less than one minute, has helped healthcare professionals accurately identify stroke patients.   If bystanders can relay results of this test to an emergency dispatcher, it could speed treatment to stroke patients.  Time is crucial in treating stroke.

      A clot-busting drug has been shown to limit disability from strokes cause by clots (ischemic strokes), but the drug must be given within three hours of the onset of stroke symptoms.  Because of this short time window, only a small percentage of patients are eligible to receive the drug.

      “As the brain is deprived of oxygen during a stroke, it’s literally starving minute-by-minute.  The sooner the patient receives proper treatment in the appropriate medical setting, the better the chances for a full recovery,” says Amy S. Hurwitz, a second-year medical student at the University of North Carolina-Chapel Hill School of Medicine in Chapel Hill, N.C.

      Hurwitz is the lead author on a study designed by Jane H. Brice, M.D., assistant professor of emergency medicine at the same institution.  The study examines whether members of the public can effectively administer the simple three-item examination that healthcare professionals use.  It is  known as the Cincinnati Prehospital Stroke Scale (CPSS).

      Researchers modified the CPSS into a script for over-the-phone administration via a layperson intermediary.  They recruited stroke survivors from the hospital’s support group.  Some of these volunteers still had one, two or three of the unresolved symptoms identified from a previous stroke, such as facial weakness, arm weakness and/or speech deficits.

      Researchers then recruited 100 non-patient visitors (bystanders) to the UNC hospital’s emergency department and brought the people to a quiet room where a stroke survivor and investigator were waiting.  The bystanders were instructed to “answer the telephone when it rings” and to follow the directions given over the phone, using the stroke survivor as their mock patient.  A researcher role-played a dispatcher implementing the CPSS script.

      Results indicate that the bystanders correctly administered CPSS directions 96 percent of the time.  When stroke patients were told to raise both arms and keep them up, bystanders were 97 percent accurate in detecting arm weakness, and 72 percent accurate in determining the lack of arm weakness.  When patients were asked to repeat a sentence, bystanders were 96 percent accurate at detecting speech deficits and 96 percent accurate in detecting a lack of speech deficit.  The bystanders were 74 percent accurate in finding facial weakness based on the stroke patient’s smile and 94 percent accurate on the absence of facial weakness.

      “While treating stroke patients may require extensive training and expensive equipment, our study shows that untrained adults can successfully detect stroke symptoms.  This ability can allow a bystander to act as ‘eyes and ears’ for a 9-1-1 dispatcher who may be miles away,” Hurwitz says.  “Unlike other investigations that strive to improve the treatment of stroke within the hospital setting, this study taps into the general public as a first-line resource in the diagnosis and triage of possible stroke victims.”

      The bystanders in the study scored high when detecting arm weakness and slurred speech – two key symptoms suggesting a patient may have had a stroke.  They were less successful detecting facial weakness, probably because it’s hard to assess a stranger’s smile, according to Hurwitz.  If the possible stroke patient was the bystander’s spouse, it’s likely the bystander would more readily detect an abrupt change in the quality of the smile, she says.

      “The general public should remember the three items tested by the CPSS.  Therefore, if a family member’s speech unexpectedly becomes slurred or incomprehensible, you should call 9-1-1 immediately.  Similarly, if one side of someone’s body ‘goes numb’ or if one side of the face droops down, you should call for help immediately,” Hurwitz says. 

      Delaying medical attention is dangerous when someone is having a stroke, since continued oxygen deprivation can cause brain damage.  “As the medical profession strives to improve the diagnosis and treatment of stroke, so should the general public aim to access this medical attention as quickly as possible,” she says.

      Hurwitz says the next step is to test layperson administration of the test in the field with real patients and emergency dispatchers.  “We will train dispatchers to lead callers through the CPSS assessment of the stroke victim.  We will then compare the survival and symptom outcomes of patients who are screened with the CPSS with a subset of patients who do not receive the screening.  By statistically comparing the patient outcomes … we can assess whether the addition of the CPSS to the dispatcher’s repertoire would benefit future stroke victims and their families,” she says.

      Co-authors of the study are Barbara A. Overby, R.N., and Kelly R. Evenson, Ph.D.  The study was partly funded by the American Stroke Association and the UNC Medical Alumni Foundation.

        NR03 –1007 (ISC03/Hurwitz)

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