Cincinnati Stroke Scale Scoring

Identify stroke symptoms with the Cincinnati Stroke Scale Scoring guide, which is essential for emergency responders and healthcare professionals.

By Patricia Buenaventura on Aug 2, 2025.

Fact Checked by Ericka Pingol.

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What is the Cincinnati Prehospital Stroke Scale?

The Cincinnati Prehospital Stroke Scale (CPSS) is a clinical tool or popular health stroke scale highly regarded in emergency medicine that emergency responders use to quickly assess a person for signs of a stroke before they reach the hospital or while they are in the emergency department. It’s designed to be simple and rapid, enabling first responders to identify patients with potential strokes and expedite the transport of patients to facilities equipped to provide necessary care.

It plays a crucial role in field assessment stroke triage by triaging patients to the appropriate medical facility based on the severity of their symptoms. Furthermore, the Cincinnati Prehospital Stroke Scale (CPSS) has become a cornerstone in emergency medical services (EMS) for identifying patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO).

The primary purpose of the CPSS is to facilitate early stroke detection in the prehospital setting. Early recognition of stroke symptoms is critical for improving outcomes, as treatments for stroke are most effective when administered as soon as possible after symptom onset. The CPSS, along with various stroke scales like the NIH stroke scale or the rapid arterial occlusion evaluation scale, helps make quick patient care and transport decisions, ensuring stroke patients receive the urgent treatment they need.

The CPSS examines three key symptoms, which are facial droop, arm drift, and speech, each of which corresponds to common acute stroke first signs:

Facial droop: The patient is asked to smile or show their teeth. A positive sign of stroke is observed if one side of the face droops or moves less well than the other side.
Arm drift: The patient is asked to close their eyes and extend both arms straight out in front with palms up for about 10 seconds. A positive indication of stroke is if one arm drifts downward compared to the other or if the patient is unable to hold one arm up.
Speech: The patient is asked to repeat simple sentences like “The sky is blue in Cincinnati.” Signs of a stroke include slurred speech, the use of incorrect words, or the inability to speak.

A positive finding in one or both eyes suggests the possibility of a stroke, warranting rapid transport to a stroke center for further evaluation and treatment.

Cincinnati Stroke Scale Scoring Template

Cincinnati Stroke Scale Scoring PDF Template

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How do you score on the Cincinnati Prehospital Stroke Scale?

The Cincinnati Prehospital Stroke Scale scoring involves evaluating three simple tests related to facial movement, arm strength, and speech clarity. Each test is scored based on the presence (abnormal) or absence (normal) of specific stroke symptoms:

Facial droop: Ask the patient to smile or show their teeth.
- Normal: Both sides of the face move equally.
- Abnormal: One side of the face moves less than the other, indicating a droop.
Normal: Both sides of the face move equally.
Abnormal: One side of the face moves less than the other, indicating a droop.
Arm drift: Instruct the patient to close their eyes and extend both arms forward with palms up for about 10 seconds.
- Normal: Both arms stay in place or move equally.
- Abnormal: One arm drifts downward or cannot be held up, indicating weakness.
Normal: Both arms stay in place or move equally.
Abnormal: One arm drifts downward or cannot be held up, indicating weakness.
Speech: Ask the patient to repeat a simple phrase.
- Normal: Speech is clear and correct.
- Abnormal: Speech is slurred, incorrect, or the patient cannot speak, indicating difficulty.
Normal: Speech is clear and correct.
Abnormal: Speech is slurred, incorrect, or the patient cannot speak, indicating difficulty.

A Cincinnati Stroke Scale Score is positive for a potential stroke if any tests show abnormal findings any of these tests show abnormal results.

Stroke scale interpretations

Interpreting the results of the CPSS is a critical step in the early detection and management of stroke symptoms. This scale provides first responders and healthcare professionals with a rapid prehospital stroke screening tool to identify signs indicative of a stroke.

Normal findings

Normal findings in the CPSS indicate that the patient can symmetrically move their face, hold both or her arms steadily without drifting, and repeat a simple phrase clearly without slurring words. Normal results suggest that, based on this quick assessment, there are no apparent signs of a stroke, but they do not rule out a stroke or other medical conditions entirely.

Abnormal findings

Abnormal findings in any of the three CPSS tests suggest a possible stroke and the need for immediate medical evaluation and intervention. Specifically:

Facial droop: Suggests possible weakness or paralysis on one side of the face.
Arm drift: Indicates weakness or lack of coordination in one arm.
Speech difficulty: Points to problems with language skills or speech articulation.

Abnormal findings necessitate urgent transport to a hospital with a comprehensive stroke center and treatment capabilities, as early intervention is crucial in minimizing the long-term impacts of a stroke.

Next steps

After identifying patients presenting potential stroke symptoms using the CPSS, the following steps are crucial in ensuring the patient receives the appropriate care swiftly. These include:

Immediate action: If the CPSS indicates abnormal findings, it's vital to act immediately. Emergency medical services should be contacted without delay to transport the patient to a medical facility specializing in stroke care.
Hospital evaluation: Upon arrival, the patient will undergo a comprehensive evaluation, including imaging tests like CT scans or MRIs, to confirm the stroke diagnosis and determine its type and severity.
Treatment plan: A tailored treatment plan will be developed based on the evaluation results. This could involve medication to dissolve clots (for ischemic strokes), surgery to remove the clot or repair damaged blood vessels (for hemorrhagic strokes), or other interventions aimed at minimizing brain damage and improving recovery.
Rehabilitation: Post-acute treatment, a rehabilitation plan is often necessary to help the patient regain lost functions and adapt to permanent changes. Rehabilitation may include physical therapy, occupational therapy, speech therapy, and psychological support.
Preventive measures: Finally, to prevent future strokes, healthcare providers will recommend lifestyle modifications and possibly medications to manage risk factors such as high blood pressure, diabetes, and high cholesterol.

Utilizing Carepatron for scale-scoring streamlines these steps, ensuring that healthcare professionals can efficiently document assessments, track patient progress, and coordinate care across the treatment continuum.

Commonly asked questions

The Cincinnati stroke scale is a quick assessment tool that healthcare professionals use to identify potential stroke symptoms in patients. It evaluates three key areas, facial droop, arm drift, and speech abnormalities, to determine the likelihood of a stroke.

The CPSS does not utilize numerical score values. Instead, it identifies suspected stroke symptoms based on three tests. If any of the tests—facial droop, arm drift, or speech difficulties—show abnormalities, it suggests a possible stroke.

To use the stroke severity scoring template on Carepatron, log into your account and navigate to the template section. Select the stroke scale scoring template and input the individual patient data, including the facial droop, arm drift, and speech tests. Carepatron will help organize and store this information for easy access and follow-up.