Prehospital identification of large vessel occlusion using the FAST-ED score.
EMS
large vessel occlusion
stroke
Journal
Acta neurologica Scandinavica
ISSN: 1600-0404
Titre abrégé: Acta Neurol Scand
Pays: Denmark
ID NLM: 0370336
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
revised:
16
04
2021
received:
10
02
2021
accepted:
04
05
2021
pubmed:
25
5
2021
medline:
26
11
2021
entrez:
24
5
2021
Statut:
ppublish
Résumé
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. 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. 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). 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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
400-407Informations de copyright
© 2021 The Authors. Acta Neurologica Scandinavica published by John Wiley & Sons Ltd.
Références
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11-21.
Mohamad NF, Hastrup S, Rasmussen M, et al. Bypassing primary stroke centre reduces delay and improves outcomes for patients with large vessel occlusion. Eur J Stroke. 2016;1:85-92.
Brandler ES, Sharma M, Sinert RH, Levine SR. Prehospital stroke scales in urban environments: a systematic review. Neurology. 2014;82:2241-2249.
Perez de la Ossa N, Carrera D, Gorchs M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke. 2014;45:87-91.
Rodríguez-Pardo J, Riera-López N, Fuentes B, et al. Madrid Stroke Network Study Group. Prehospital selection of thrombectomy candidates beyond large vessel occlusion: M-DIRECT scale. Neurology. 2020;94:e851-e860. https://doi.org/10.1212/WNL.0000000000008998.
Lima FO, Silva GS, Furie KL, et al. Field assessment stroke triage for emergency destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes. Stroke. 2016;47:1997-2002.
Ollikainen JP, Janhunen HV, Tynkkynen JA, et al. The finnish prehospital stroke scale detects thrombectomy and thrombolysis candidates-a propensity score-matched study. J Stroke Cerebrovasc Dis. 2018;27:771-777.
Noorian AR, Sanossian N, Shkirkova K, et al. Los Angeles motor scale to identify large vessel occlusion: prehospital validation and comparison with other screens. Stroke. 2018;49:565-572.
Turc G, Maïer NO, Seners P, et al. Clinical scales do not reliably identify acute ischemic stroke patients with large-artery occlusion. Stroke. 2016;47:1466-1472.
Nguyen TTM, van den Wijngaard IR, Bosch J, et al. Comparison of prehospital scales for predicting large anterior vessel occlusion in the ambulance setting. JAMA Neurology. 2021;78(2):157-https://doi.org/10.1001/jamaneurol.2020.4418.
Nogueira RG, Silva GS, Lima FO, et al. The FAST-ED App: a smartphone platform for the field triage of patients with stroke. Stroke. 2017;48:1278-1284.
Carr K, Yang Y, Roach A, Shivashankar R, Pasquale D, Serulle Y. Mechanical Revascularization in the Era of the Field Assessment Stroke Triage for Emergency Destination (FAST-ED): A Retrospective Cohort Assessment in a Community Stroke Practice. J Stroke Cerebrovasc Dis. 2020;29:104472. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104472.
Rynor H, Levine J, Souchak J, et al. The Effect of a County Prehospital FAST-ED Initiative on Endovascular Treatment Times. Journal of Stroke and Cerebrovascular Diseases. 2020;29(11):105220-https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105220.
Dowbiggin PL, Infinger AI, Purick G, Swanson DR, Studnek JR. Inter-Rater Reliability of the FAST-ED in the Out-of-Hospital Setting. Prehosp Emerg Care. 2021;1-8: https://doi.org/10.1080/10903127.2020.1852350.
Nor AM, McAllister C, Louw SJ, et al. Agreement between ambulance paramedic- and physician-recorded neurological signs with Face Arm Speech Test (FAST) in acute stroke patients. Stroke. 2004;35:1355-1359.
Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012;79:306-313.
Strbian D, Ringleb P, Michel P, et al. Ultra-early intravenous stroke thrombolysis: do all patients benefit similarly? Stroke. 2013;44:2913-2916.
Puolakka T, Strbian D, Harve H, Kuisma M, Lindsberg PJ. Prehospital phase of the stroke chain of survival: a prospective observational study. J Am Heart Assoc. 2016;5:e002808.
Puolakka T, Kuisma M, Länkimäki S, et al. Cutting the prehospital on-scene time of stroke thrombolysis in Helsinki: a prospective interventional study. Stroke. 2016;47:3038-3040.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29-36.
Turc G, Maïer B, Naggara O, et al. Clinical scales do not reliably identify acute ischemic stroke patients with large-artery occlusion. Stroke. 2016;47:1466-1472.
Turc G. Mothership or drip-and-ship in the era of thrombectomy: can we use prehospital clinical scales as a compass? Eur J Neurol. 2017;24:543-544.
Zhao H, Coote S, Pesavento L, et al. Large vessel occlusion scales increase delivery to endovascular centers without excessive harm from misclassifications. Stroke. 2017;48:568-573.
Abilleira S, Pérez de la Ossa N, Jiménez X, et al. Transfer to the local stroke center versus direct transfer to endovascular center of acute stroke patients with suspected large vessel occlusion in the catalan territory (RACECAT): Study protocol of a cluster randomized within a cohort trial. Int J Stroke. 2019;14:734-744.
Rodríguez-Pardo J, Fuentes B, Alonso de Leciñana M, et al. Madrid Stroke Network. The Direct Referral to Endovascular Center criteria: a proposal for pre-hospital evaluation of acute stroke in the Madrid Stroke Network. Eur J Neurol. 2017;24:509-515.