Time is brain, so we must BEFAST: Improving stroke identification and triage in a rural emergency department.
cerebrovascular accident
emergency service
stroke
triage
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
02 Jan 2024
02 Jan 2024
Historique:
revised:
14
11
2023
received:
05
07
2023
accepted:
18
12
2023
medline:
4
1
2024
pubmed:
4
1
2024
entrez:
3
1
2024
Statut:
aheadofprint
Résumé
Shoalhaven District Memorial Hospital is a rural (MM3) secondary hospital which is over an hour travel time from the nearest tertiary centre. The objective of the present study was to pilot the implementation of the BEFAST (Balance, Eyes, Face, Arms, Speech and Time) stroke screening tool at the ED, and determine whether its usage improved timely stroke detection. During initial implementation and training (October-December 2019), triage nurses consulted with senior medical officers before activating stroke calls. Data were collected for the subsequent 24 months (January 2020-2022), and retrospective records for confirmed strokes during a 24-month period prior to BEFAST implementation (October 2017-2019) were also collected. The main outcome measures were triage category, CT scan result time, discharge destination, length of stay (LOS) and Modified Rankin Score (MRS). After BEFAST implementation, patients (n = 268) were three times more likely to be triaged at category 1 or 2, and door-to-CT scan time was reduced by 20.7 min on average. More patients were discharged to their usual residence and more quickly (LOS 7.9 vs 11.1 days). MRS 90 days after stroke was less, and patients were nearly twice as likely to experience an improvement in neurological symptoms. Patient outcomes were improved after implementation of the BEFAST stroke triage tool. More stroke patients were identified upon presentation to the ED, and in a timely fashion. For those with a stroke diagnosis, time-critical interventions can take place earlier, allowing patients to return home sooner, and with less disability.
Identifiants
pubmed: 38168903
doi: 10.1111/1742-6723.14369
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Australasian College for Emergency Medicine.
Références
Saver JL. Time is brain - quantified. Stroke 2006; 37: 263-266.
Vanamoorthy P, Bidkar PU. Acute ischemic stroke. In: Vanamoorthy P, Bidkar PU, eds. Acute Neuro Care: Focused Approach to Neuroemergencies. Singapore: Springer Singapore, 2020; 209-237.
Berglund A, Svensson L, Wahlgren N, von Euler M. Face arm speech time test use in the prehospital setting, better in the ambulance than in the emergency medical communication center. Cerebrovasc. Dis. 2014; 37: 212-216.
Australian Institute of Health and Welfare. Australia's Health Snapshots 2020 [Internet]. Canberra, Australia; 2020 [Cited 2 Sep 2020]. Available from URL: https://www.aihw.gov.au/reports-data/australias-health/australias-health-snapshots
Australian Institute of Health and Welfare. Stroke and its Management in Australia: An Update [Internet]. Canberra, Australia; 2013 [Cted 2 Sep 2020]. Available from URL: https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/stroke-management-australia-update/contents/table-of-contents
Suri V, Suri K. Acute ischemic stroke (AIS). In: Rajesh C, Todi S, eds. ICU Protocols: A Step-Wise Approach, Vol. I. Singapore: Springer Singapore, 2020; 271-283.
Greer DM, Beekman RB, Johnon MH, Huttner AJ. Cerebrovascular disease. In: Rosenberg RN, ed. Atlas of Clinical Neurology. Cham: Springer International Publishing, 2019; 167-285.
Stroke Foundation. Australian Clinical Guidelines for Stroke Management v9.0 [Internet]. Stroke Foundation; 2021 [Cited 19 May 2021]. Chapter 3: Acute medical and surgical management. Available from URL: https://app.magicapp.org/#/guideline/QnoKGn/section/EQvlDj
Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): reducing the proportion of strokes missed using the FAST mnemonic. Stroke 2017; 48: 479-481.
Pickham D, Valdez A, Demeestere J et al. Prognostic value of BEFAST vs. FAST to identify stroke in a prehospital setting. Prehosp. Emerg. Care 2019; 23: 195-200.
Merwick Á, Werring D. Posterior circulation ischaemic stroke. BMJ 2014; 348: g3175.
Jones SP, Bray JE, Gibson JME et al. Characteristics of patients who had a stroke not initially identified during emergency prehospital assessment: a systematic review. Emerg. Med. J. 2021; 38: 387-393.
Chen X, Zhao X, Xu F et al. A systematic review and meta-analysis comparing FAST and BEFAST in acute stroke patients. Front Neurol 2022; 12. https://doi.org/10.3389/fneur.2021.765069
el Ammar F, Ardelt A, del Brutto VJ et al. BE-FAST: a sensitive screening tool to identify in-hospital acute ischemic stroke. J. Stroke Cerebrovasc. Dis. 2020; 29: 104821.
The Jamovi Project. Jamovi [Internet]; 2020. Available from URL: www.jamovi.org
National Institute of Neurological Disorders and Stroke. NIH Stroke Scale [Internet]; 2003 [Cited 21 Sep 2023]. Available from URL: https://www.ninds.nih.gov/sites/default/files/documents/NIH_Stroke_Scale_508C_0.pdf
Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin Scale: implications for stroke clinical trials. Stroke 2007; 38: 1091-1096.