Prehospital identification of large vessel occlusion using the FAST-ED score

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http://hdl.handle.net/10138/340444

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Puolakka , T , Virtanen , P , Kinnunen , J , Kuisma , M & Strbian , D 2021 , ' Prehospital identification of large vessel occlusion using the FAST-ED score ' , Acta Neurologica Scandinavica , vol. 144 , no. 4 , pp. 400-407 . https://doi.org/10.1111/ane.13474

Title: Prehospital identification of large vessel occlusion using the FAST-ED score
Author: Puolakka, Tuukka; Virtanen, Pekka; Kinnunen, Janne; Kuisma, Markku; Strbian, Daniel
Contributor organization: HUS Emergency Medicine and Services
University of Helsinki
Anestesiologian yksikkö
Helsinki University Hospital Area
HUS Medical Imaging Center
Neurologian yksikkö
HUS Neurocenter
Date: 2021-10
Language: eng
Number of pages: 8
Belongs to series: Acta Neurologica Scandinavica
ISSN: 0001-6314
DOI: https://doi.org/10.1111/ane.13474
URI: http://hdl.handle.net/10138/340444
Abstract: Objectives The prehospital identification of stroke patients with large vessel occlusion (LVO) enables appropriate hospital selection and reduces the onset-to-treatment time. The aim of this study was to investigate whether the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale could be reconstructed from existing prehospital patient reports and to compare its performance with neurologist's clinical judgement using the same prehospital data. Materials & Methods All patients transported by ambulance using stroke code on a six-month period were registered for the study. The prehospital patient reports were retrospectively evaluated using the FAST-ED scale by two investigators. The performance of FAST-ED score (>= 4 points) in LVO identification was compared to neurologist's clinical judgement ('LVO or not'). The presence of LVO was verified using computed tomography angiography imaging. Results A total of 610 FAST-ED scores were obtained. The FAST-ED had a sensitivity of 57.8%, specificity of 87.2%, positive predictive value (PPV) of 37.3%, negative predictive value (NPV) of 93.4% and area under curve (AUC) of 0.724. Interclass correlation coefficient for both raters over the entire range of FAST-ED was 0.92 (0.88-0.94). The neurologist's clinical judgement raised sensitivity to 79.4%, NPV to 97.1% and PPV to 45.0% with an AUC of 0.837 (p < .05). Conclusions The existing patient report data could be feasibly used to reconstruct FAST-ED scores to identify LVO. The binary FAST-ED score had a moderate sensitivity and good specificity for prehospital LVO identification. However, the FAST-ED was surpassed by neurologist's clinical judgement which further increased the sensitivity of identification.
Subject: EMS
large vessel occlusion
stroke
CLINICAL-SCALES
STROKE SCALE
THROMBOLYSIS
THROMBECTOMY
VALIDATION
TRIAGE
DELAY
3112 Neurosciences
3124 Neurology and psychiatry
Peer reviewed: Yes
Rights: cc_by_nc_nd
Usage restriction: openAccess
Self-archived version: publishedVersion


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