Peoria Posterior Fossa Stroke Scale: A New Scale to Assess the Severity of Posterior Fossa Stroke Symptoms and Outcomes

TL;DR

The Peoria Posterior Fossa Stroke Scale (PPFSS) is a new tool designed to help healthcare providers quickly assess the severity of posterior fossa strokes, complementing existing stroke scales.

Contribution

The PPFSS introduces a novel, six-section scoring system specifically for posterior fossa stroke assessment in acute settings.

Findings

The PPFSS includes sections on eyes, nystagmus, head impulse, hearing, pharynx, and balance.

The scale was developed with input from vascular neurologists and a neuro-ophthalmologist.

The PPFSS is intended for use in pre-hospital, emergency, and inpatient settings.

Abstract

Introduction: Posterior fossa strokes often present with symptoms that are less obvious and can overlap with other conditions. While the National Institutes of Health Stroke Scale (NIHSS) remains a valuable tool for stroke assessment, its limitations in posterior fossa strokes necessitate a complementary approach. A posterior fossa stroke scale developed with standard protocols for use in various settings, such as pre-hospital, emergency department, and inpatient care, could ensure early identification and timely treatment. For this reason, the Peoria Posterior Fossa Stroke Scale (PPFSS) was created with the objective of creating an add-on to the NIHSS to allow for the assessment of the possibility of a posterior fossa stroke by any healthcare provider.

Materials and methods: A literature review of peer-reviewed publications via PubMed was conducted to identify clinical signs and symptoms associated with posterior fossa strokes and existing posterior fossa stroke scales. A preliminary scale draft was created and formatted for easy bedside application, which was then discussed with a panel of five vascular fellowship-trained neurologists and later a neuro-ophthalmologist to create a finalized scale.

Proposed scale: The PPFSS consists of a six-section scoring system with a range of scores of zero to 15 and includes sections that include eyes, nystagmus, head impulse, hearing, pharynx, and balance that would be used in the acute setting of those suspected to have posterior fossa strokes.

Limitations and future directions: Further research into the PPFSS would need to be done to validate its use. This would include testing in real-world settings to determine the sensitivity and specificity of PPFSS in identifying posterior circulation strokes, inter-rater reliability as measured by Cohen’s kappa, and comparison to other scoring systems. Cognitive dysfunction of the patient and interrater reliability may factor into the scoring of the PPFSS.

Conclusion: A standardized, easy-to-use approach for assessing posterior fossa strokes could ensure consistency in diagnosis and treatment across healthcare settings. The PPFSS was developed as a potentially usable scale at bedside in the acute stroke setting that is ready for a validation research study.