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

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PHOENIX, Feb. 13 – A bystander may be able to spot someone having a stroke by giving the person a simple, quicktest to see if they can smile, raise both arms and keep them up, and speak a simple sentence coherently, according toa report presented today at the American Stroke Association's 28th International Stroke Conference. The AmericanStroke 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 strokepatients. 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 drugmust be given within three hours of the onset of stroke symptoms. Because of this short time window, only a smallpercentage 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 thepatient 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 ofMedicine 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 atthe 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. Theyrecruited stroke survivors from the hospital's support group. Some of these volunteers still had one, two or threeof the unresolved symptoms identified from a previous stroke, such as facial weakness, arm weakness and/or speechdeficits.

Researchers then recruited 100 non-patient visitors (bystanders) to the UNC hospital's emergency department andbrought the people to a quiet room where a stroke survivor and investigator were waiting. The bystanders wereinstructed to "answer the telephone when it rings" and to follow the directions given over the phone, using thestroke 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 strokepatients were told to raise both arms and keep them up, bystanders were 97 percent accurate in detecting armweakness, and 72 percent accurate in determining the lack of arm weakness. When patients were asked to repeat asentence, bystanders were 96 percent accurate at detecting speech deficits and 96 percent accurate in detecting alack of speech deficit. The bystanders were 74 percent accurate in finding facial weakness based on the strokepatient'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 thatuntrained adults can successfully detect stroke symptoms. This ability can allow a bystander to act as 'eyes andears' 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 studytaps 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 suggestinga patient may have had a stroke. They were less successful detecting facial weakness, probably because it's hard toassess a stranger's smile, according to Hurwitz. If the possible stroke patient was the bystander's spouse, it'slikely 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 speechunexpectedly 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, youshould call for help immediately," Hurwitz says.

Delaying medical attention is dangerous when someone is having a stroke, since continued oxygen deprivation cancause brain damage. "As the medical profession strives to improve the diagnosis and treatment of stroke, soshould 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 andemergency dispatchers. "We will train dispatchers to lead callers through the CPSS assessment of the strokevictim. We will then compare the survival and symptom outcomes of patients who are screened with the CPSS witha subset of patients who do not receive the screening. By statistically comparing the patient outcomes, wecan assess whether the addition of the CPSS to the dispatcher's repertoire would benefit future stroke victimsand 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 bythe American Stroke Association and the UNC Medical Alumni Foundation.