Gropen et al developed the Emergency Medical Stroke Assessment (EMSA) scale for prehospital evaluation of a patient with stroke. The authors are from multiple institutions in the United States.
Patient selection: possible stroke
Parameters:
(1) eye movement (ability to follow a finger)
(2) facial weakness (facial symmetry when smiling and showing teeth)
(3) arm weakness (ability to hold out with palms up for 10 seconds with eyes closed)
(4) leg weakness (ability to lift a leg up for 5 seconds)
(5) slurred speech or aphasia (ability to name common objects and repeat a phrase)
Parameter
Finding
Points
eye movement
normal
0
abnormal
1
facial weakness
absent
0
present
1
arm weakness
absent
0
present
1
leg weakness
absent
0
present
1
slurred speech or aphasia
absent
0
present
2
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• A score >= 3 is suggestive of a large vessel occlusion.
Performance:
• The area under the ROC curve for recognition of large vessel obstruction is 0.69.
• A score >= 3 was 75% sensitive and 50% specific for large vessel obstruction.
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