About the MEND
MEND is an acronym for Miami Emergency Neurologic Deficit. The MEND is an easy-to-learn, easy-to- use checklist that provides key information. It incorporates the three components of the Cincinnati Prehospital Stroke Scale (CPSS) as well as additional components from the NIH Stroke Scale (NIHSS). Both of these are validated tools.
The MEND exam was devised to facilitate communication between healthcare providers throughout the continuum of care for stroke patients. The same tool can be used to obtain a baseline exam in the prehospital setting and then for initial evaluation and subsequent exams in the emergency department, ICU, or hospital floor.
The need for the MEND exam arose because the NIHSS, while very thorough, is also a time-consuming exam. It is not feasible to perform in the prehospital setting and on regular neurologic evaluations by nurses. Conversely, although the CPSS is a quick screening examination, it has only a 70% sensitivity to detect stroke in the field, it is not used in the hospital setting, and is missing components that are important for localization, severity and interval changes. The MEND exam is more thorough than the CPSS but takes less than 3 minutes to perform and requires no additional tools. This allows for quick, yet detailed initial exams and interval assessments. A recent study evaluating the use of the MEND examination as part of a decision tool to air transport patients from the scene to a comprehensive stroke center found that it had a 90% correlation with the NIHSS.
Using the MEND Exam
Our recommendation in the prehospital setting is that the CPSS be performed on scene and the MEND exam be performed en route, to minimize transport delays. In the hospital setting, the NIHSS, the gold standard neurologic exam, must be performed initially as part of the decision to give IV tPA or perform other interventions and at regular intervals. We recommend the MEND exam be used by nurses initially and for frequent neurologic reexaminations. Anecdotally, the usefulness, feasibility, and reproducibility of the MEND exam have all been very positive from the institutions and departments that have adopted it.
Learning the MEND Exam
The MEND exam is best understood within the context of the full ASLS® course, which has a chapter devoted to teaching participants to perform a focused neurologic assessment. The lecture is followed by hands-on sessions in which learners practice the MEND on simulated and standardized patients who have normal and abnormal neurologic examinations.
Availability of the MEND Exam
Digital copies of both versions of the MEND exam — prehospital and in-hospital — are included with the ASLS® curriculum package. ASLS® Training Centers may reproduce the MEND checklists for use by learners in its courses along with the preprinted posters that are also part of the initial toolkit. Laminated pockets guides aid learners to recall the MEND components in the field. ASLS® TCs may also reproduce the MEND checklists for application in a clinical setting by its personnel. This includes integrating the MEND in its electronic patient recordkeeping system, as long as the GCRME identification and copyright information are maintained.
Both prehospital and in-hospital versions of the MEND checklist are incorporated into downloadable applications from the Apple iTunes store for use on the iPhone and iPad to aid healthcare providers in the assessment and management of stroke patients. MEND apps for Android can be found at Google's Play store: Hospital / EMS
Tabbed dividers in the MEND EMS app allow the user to navigate in order from the history to the MEND examination, management considerations, and emergency department report. The components on the CPSS and MEND exam are provided in a checklist format. The ED Report screen summarizes all of the data collected into an organized bullet point list for clear radio communication with the receiving hospital emergency department.
In the MEND Hospital app, the tabbed dividers help users navigate through the first 60 minutes of caring for an acute stroke patient, the MEND exam with sequential scores for monitoring, t-PA indications and contraindications, and post t-PA care. There is a prompt to indicate starting with a new patient or to resume entering information on an existing patient.