In regards to the LAMS score, is it to be used for acute changes only if a patient has deficits from a previous stroke? For example, if the patient already has a weak grip and arm drift from a previous stroke with no reports of acute changes, however they have facial droop that is reported to be new then is only the one point for facial droop counted?

Per the BLS-PCS Acute Stroke Bypass Protocol, assess the patient to determine if he/she has one or more of the symptoms consistent with an acute stroke, as follows, (a) inappropriate words or mute, (b) slurred speech, (c) unilateral arm weakness or drift, (d) unilateral facial droop, or, (e) unilateral leg weakness of drift. If any of these symptoms are new or worsening (symptoms consistent with acute stroke) then you should continue with your assessment and apply the Los Angeles Motor Scale (LAMS) as appropriate.

In the situation you describe, you are correct.  The patient would be considered for bypass given the new unilateral facial droop (assuming they meet the symptom onset and transport timing criteria). You would then perform a secondary screening for Large Vessel Occlusion (LVO) stroke using the LAMS score. For which they would receive 1 point for facial droop, given the other deficits are not new or worsening.

The history of previous stroke and deficits should be communicated directly to the stroke team to assist them in determining the best treatment for the patient.

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