Objective: To develop an abbreviated and practical neurologic scale that could assist emergency medical services or triage personnel in identifying patients with stroke. Methods: A prospective, observational, cohort study was performed at university-based EDs. Participants were 74 patients treated in a thrombolytic stroke trial and 225 consecutive non-stroke patients evaluated during 4 random 12-hour shifts in the ED. Scores on the NIH Stroke Scale were obtained for all patients by physicians. Items of this scale were modified and recoded to a binomial (normal or abnormal) scale. Serial univariate analyses using x2 were performed to rank items. Recursive partitioning was then performed to develop the decision rule for predicting the presence of stroke. Results: Three items identified 100% of patients with stroke: facial palsy, motor arm, and dysarthria. An Abbreviated NZH Stroke Scale based on these items had a sensitivity of 100% and a specificity of 92%. A proposed Out-ofhospital NZH Stroke Scale consisting of facial palsy, motor arm, and a combination of dysarthria and best language items (abnormal speech) had a sensitivity of 100% and a specificity of 88%. Conclusion: Using the derivation data set, a proposed Out-ofhospital NZH Stroke Scale had a high sensitivity and specificity for identifying patients with stroke when performed by physicians in this group of 299 ED patients. Prospective studies of other health care professionals using the scale in the out-of-hospital arena are needed. Key words: out-of-hospital; emergency medical services; EMS; paramedic; stroke; cerebral ischemia; diagnosis; score. are 30% more likely to have excellent neurologic recovery at 3 months than are those treated with placebo.' The mobilization of a stroke team is an effective method of treating patients within this narrow therapeutic window.' Often the first step in mobilizing a stroke team is advance notification of the receiving ED by emergency medical services (EMS) personnel or other nonphysician medical personnel."-5 Developing a rapid, accurate method for EMS or triage personnel to identify patients with stroke could reduce the time to physician evaluation for patients with potentially treatable strokes who present to the ED. Currently, a nonstandardized history and physical examination are the primary tools used to identify potential stroke patients in the field.The NIH Stroke Scale is a 15-item measure of neurologic function used in clinical stroke trials.6 This scale assesses neurologic deficits and was designed to provide a reliable, valid, and easy-to-perform alternative to the standard neurologic examinati~n.'.~ The goal of this preliminary study was to develop an abbreviated and practical neurologic scale, derived from the NIH Stroke Scale, that could assist EMS or other medical personnel in identifying patients with stroke.

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