Medical reference
Prehospital stroke scales.
Cincinnati screens. LAMS and RACE grade severity for CSC bypass. Here's the whole map.
Cincinnati Prehospital Stroke Scale (CPSS)
Three items. Any one abnormal = positive screen.
- Facial droop — ask patient to smile / show teeth.
- Arm drift — arms out, palms up, eyes closed for 10 sec.
- Abnormal speech — repeat "You can't teach an old dog new tricks."
LAMS (Los Angeles Motor Scale)
0–5 severity from three motor items. LAMS ≥ 4 suggests LVO.
| Item | 0 | 1 | 2 |
|---|---|---|---|
| Facial droop | Absent | Present | — |
| Arm drift | Absent | Drifts down | Falls rapidly |
| Grip strength | Normal | Weak | No grip |
RACE (Rapid Arterial oCclusion Evaluation)
0–9 severity across 5 items. RACE ≥ 5 suggests LVO.
- Facial palsy (0–2)
- Arm motor (0–2)
- Leg motor (0–2)
- Head/gaze deviation (0–1)
- Aphasia (left hemisphere) or agnosia (right) (0–2)
Field pearl
Document last known well, blood glucose, medications (especially anticoagulants), and time of scale — the receiving stroke team lives on those data points.
Stroke mimics
- Hypoglycemia — always check a glucose.
- Seizure with post-ictal Todd's paralysis.
- Complex migraine.
- Bell's palsy — spares the forehead.
- Sepsis or severe electrolyte disturbance.
Frequently asked
- Which stroke scale should EMS use?
- Cincinnati (CPSS) is the fastest screen for any stroke. LAMS or RACE add severity — use them to decide whether to bypass a primary stroke center for a thrombectomy-capable comprehensive stroke center.
- What is a positive Cincinnati scale?
- Any one of: facial droop, arm drift, or abnormal speech. Sensitivity ~66% and specificity ~87% for stroke.
- What LAMS score triggers CSC bypass?
- LAMS ≥ 4 (0–5 scale) suggests large vessel occlusion (LVO) and thrombectomy candidacy. Many systems bypass with LAMS ≥ 4.
- What RACE score suggests LVO?
- RACE ≥ 5 (0–9 scale) has good sensitivity for LVO and is commonly used as the CSC bypass threshold.
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