Selected Topics: Prehospital Care| Volume 58, ISSUE 6, P917-921, June 2020

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Can Prehospital Personnel Accurately Triage Patients for Large Vessel Occlusion Strokes?



      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.


      We sought to determine whether prehospital FAST-ED scores are comparable with FAST-ED scores determined by emergency physicians.


      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.


      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).


      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.


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      Linked Article

      • Limitations of Prehospital Stroke Scales for Large-Vessel Occlusion Detection
        Journal of Emergency MedicineVol. 59Issue 4
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          We 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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