Los Angeles Prehospital Stroke Screen Explained

Los Angeles Prehospital Stroke Screen (LAPSS)
Purpose:	identifying potential stroke patients
Synonyms:	LAPSS

The Los Angeles Prehospital Stroke Screen (abbreviated LAPSS) is a method of identifying potential stroke patients in a pre-hospital setting.^[1]

Screening criteria

• No history of seizures or epilepsy
• Age 45 years or older
• At baseline, patient is not bedridden and does not use a wheelchair
• Blood glucose between 60 and 400 mg/dL
• Obvious asymmetry-unilateral weakness with any of the following motor exams:
  1. Facial Smile/Grimace
  2. Grip
  3. Arm Strength

If all of the above criteria are met (or not ascertainable) the LAPSS is positive for stroke. Patients 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±3.0 minutes (median, 5 minutes). The study resulted in a sensitivity of 78.44% and a specificity of 90.22%.^[4]

See also

• FAST (stroke)
• Cincinnati Prehospital Stroke Scale

Notes and References

1. http://stroke.ahajournals.org/content/34/1/71.full American Heart Association - Stroke
2. http://file.lacounty.gov/SDSInter/dhs/1040516_1232StrokeCVATIA.pdf Department of Health Services, County of Los Angeles - Treatment Protocol
3. Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). . 31 Jan 2000 . 10625718 . 31 . 1 . Stroke . 71–6 . Kidwell . CS . Starkman . S . Eckstein . M . Weems . K . Saver . JL . 10.1161/01.str.31.1.71. free .
4. Validation of the Los Angeles pre-hospital stroke screen (LAPSS) in a Chinese urban emergency medical service population. . 2013-08-07 . 23950994 . 10.1371/journal.pone.0070742 . 8 . 8 . 3737357 . PLOS ONE . e70742 . Chen . S . Sun . H . Lei . Y . Gao . D . Wang . Y . Wang . Y . Zhou . Y . Wang . A . Wang . W . Zhao . X. 2013PLoSO...870742C . free .