Abstract
Background
The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score was developed
in the hospital setting to be used in the prehospital setting. It has been shown to
have higher predictive value than comparable stroke scales, including the National
Institutes of Health Stroke Scale, for identifying large vessel occlusion strokes.
Objective
We sought to determine whether prehospital FAST-ED scores are comparable with FAST-ED
scores determined by emergency physicians.
Methods
Emergency Medical Services (EMS) personnel were trained to calculate a FAST-ED score
for any patient suspected of having a stroke in the field. When the patient arrived
at our ED, an emergency physician generated a FAST-ED score.
Results
One hundred and thirty-five patients were studied and large vessel occlusions were
detected in 23.7%. There was no significant difference between median FAST-ED scores
from EMS personnel (3; interquartile range [IQR] 1–5) and emergency physician (2;
IQR 1–6). The difference between paired scores was not significantly different from
0 (median of paired differences was 0). In addition, prehospital FAST-ED scores were
significantly and positively correlated with physician FAST-ED scores (r2 = 0.26). Comparable receiver operator curve area under the curve values were obtained
for EMS FAST-ED (0.727; 95% confidence interval [CI] 0.638–0.816) and ED FAST-ED (0.769;
95% CI 0.669–0.868).
Conclusions
The findings validate that prehospital FAST-ED scores are comparable in predictive
value to FAST-ED scores calculated in the ED for prediction of large vessel occlusion
strokes.
Keywords
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Article info
Publication history
Published online: March 21, 2020
Accepted:
January 20,
2020
Received in revised form:
December 24,
2019
Received:
October 7,
2019
Footnotes
This study was approved by the Institutional Review Board of Mount Sinai Medical Center, Miami Beach, Florida.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Limitations of Prehospital Stroke Scales for Large-Vessel Occlusion DetectionJournal of Emergency MedicineVol. 59Issue 4
- PreviewWe read with great interest Guillory et al.’s study of prehospital use of the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale for detection of large-vessel occlusions (LVO) (1). Although we acknowledge that the study is limited by an unblinded protocol, we believe that these preliminary findings hold importance. This is due to the ongoing need for a reliable and well-validated protocol for early detection and triage of LVO stroke cases to specialist centers for endovascular thrombectomy.
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