Cincinnati Prehospital Stroke Severity Scale

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Stroke severity screening

Cincinnati Prehospital Stroke Severity Scale (CP-SSS)

Predicts possible large vessel occlusion (LVO) and severe stroke in a patient with acute stroke symptoms.

Suspected stroke is an emergency. Do not delay activation of the local emergency stroke pathway in order to complete this score.

1. Conjugate gaze deviation

Observe whether the eyes are acutely deviated or gaze is impaired in one direction.

2. Ask the patient their age and the current month

Record how many of the two orientation questions are answered correctly.

3. Ask the patient to close their eyes and open/close one hand

Record how many of the two commands are followed correctly.

4. Instruct the patient to hold either or both arms up for 10 seconds

“Cannot do” indicates severe arm weakness, such as an arm falling to the bed within 10 seconds.

CP-SSS score 0 out of 4

Score breakdown

  • Conjugate gaze deviation+0
  • Abnormal questions and commands+0
  • Severe arm weakness+0
Scoring rule: conjugate gaze deviation = 2 points; severe arm weakness = 1 point; and 1 point is added only when both the age/month item and the command-following item are abnormal.

Clinical note: A score of 2 or more is the commonly used positive threshold for suspected severe stroke/LVO, but the scale does not confirm or exclude LVO.

Reference: Katz BS, McMullan JT, Sucharew H, Adeoye O, Broderick JP. Design and validation of a prehospital scale to predict stroke severity. Stroke. 2015;46:1508–1512.

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