Agreement Between Ambulance Paramedic- and Physician-Recorded Neurological Signs With Face Arm Speech Test (FAST) in Acute Stroke Patients

Abstract

Background and Purpose-Patients with suspected stroke first assessed by ambulance paramedics require early recognition to facilitate appropriate triage and early treatment. We determined paramedic's accuracy in detecting acute stroke signs by comparing agreement between neurological signs recorded in the Face Arm Speech Test (FAST), a stroke recognition instrument, by paramedics on the scene and by stroke physicians after admission. Methods-Suspected stroke patients admitted by ambulance paramedics directly to an acute stroke unit through a rapid ambulance protocol were examined by a trainee stroke neurologist or admitting stroke physician over a 1-year period. Recorded neurological signs (facial weakness, arm weakness, speech disturbance) in confirmed acute stroke/transient ischemic attack (TIA) cases were compared between paramedics and the stroke neurologist/physician. Results-Ambulance crews referred 278 suspected stroke patients of whom 217 (78%) had confirmed stroke (nϭ189) or TIA (nϭ28); 95% were examined by the stroke neurologist (median 18 hours after paramedic assessment). Recorded signs and agreement between paramedics and stroke physicians in confirmed stroke group were: facial weakness, 68% versus 70% (ϭ0.49; 95% CI: 0.36 to 0.62); arm weakness, 96% versus 95% (ϭ0.77; 95% CI: 0.55 to 0.99); and speech disturbance, 79% versus 77% (ϭ0.69; 95% CI: 0.56 to 0.82). Interrater agreement was complete for arm weakness in 98% cases. Conclusions-Recognition of neurological deficits by ambulance paramedics using FAST shows good agreement with physician assessment, even allowing for temporal evolution of deficits. The high prevalence and good agreement for arm weakness suggest that this sign may have the greatest usefulness for prehospital ambulance triage and paramedic-based neuroprotective trials.

Sequential Analysis of Pretreatment Delays In Stroke Thrombolysis

“…Scores of 0-2 were considered a good outcome. To define the effect of stroke severity on prehospital delays, the patients were divided into three groups according to the baseline NIHSS score: mild (< 7), moderate (7)(8)(9)(10)(11)(12)(13)(14)(15), and severe (> 15) stroke, as described previously. 8,9 Data Analysis Statistical analysis was performed with an SPSS 16 statistical software package (SPSS, Inc., Chicago, IL).…”

“…It has involved training of emergency medical dispatchers (EMD), ambulance personnel, and hospital staff; implementation of a stroke code and a prenotification system; and a thorough restructuring of the ED's routines and imaging facilities. 5 The EMDs receiving the emergency calls were trained to screen for stroke by seeking for signs of facial droop, acute unilateral limb weakness, and dysphasia (Face Arm Speech Test, FAST 14 ). If more than one of these requirements were met, they were directed to dispatch the nearest available ambulance unit using Median values (IQR) presented unless otherwise noted.…”

Assessing the Validity of the Cincinnati Prehospital Stroke Scale and the Medic Prehospital Assessment for Code Stroke in an Urban Emergency Medical Services Agency

“…7 The most common screens include the Cincinnati Prehospital Stroke Scale (CPSS), adapted from the hospital-based National Institutes of Health Stroke Scale for the identification of stroke in the prehospital setting, and the Los Angeles Prehospital Stroke Screen (LAPSS), developed by a prehospital and stroke expert panel. 8,9 Unfortunately, the generalizability and overall performance of the LAPSS and CPSS are unclear, [10][11][12][13][14][15][16][17] with sensitivities ranging from 44% to 91% and specificities from 33% to 97%, dependent on the population under study. With the goal of providing paramedics with a tool that was both sensitive and specific in the identification of stroke patients, a local stroke screening tool was developed in Mecklenburg County, North Carolina.…”

Identifying blood biomarkers to improve the diagnosis of stroke

“…Symposium review speech test' (FAST) and the more complex 'recognition of stroke in the emergency room' (ROSIER) instrument. The FAST was originally developed for stroke identification by paramedic ambulance crews 8 and the ROSIER for the identification of patients with stroke in emergency departments. 6 For a blood marker to be useful for the diagnosis of stroke, a single marker should perform better than a simple clinical scale when measured in addition to such a simple clinical scale.…”