Puolakka, TuukkaVirtanen, PekkaKinnunen, JanneKuisma, MarkkuStrbian, Daniel2022-02-162022-02-162021-10Puolakka, 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.13474ORCID: /0000-0002-3057-6524/work/108463464http://hdl.handle.net/10138/340444Objectives 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.8engcc_by_nc_ndinfo:eu-repo/semantics/openAccessEMSlarge vessel occlusionstrokeCLINICAL-SCALESSTROKE SCALETHROMBOLYSISTHROMBECTOMYVALIDATIONTRIAGEDELAYNeurosciencesNeurology and psychiatryArticleopenAccessf3f80220-1cf1-4b69-8b2b-db33f59cd6a7000653222300001