Field Assessment Stroke Triage for Emergency Destination A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes

dc.contributor.authorLima, Fabricio O.
dc.contributor.authorSilva, Gisele S. [UNIFESP]
dc.contributor.authorFurie, Karen L.
dc.contributor.authorFrankel, Michael R.
dc.contributor.authorLev, Michael H.
dc.contributor.authorCamargo, Erica C. S.
dc.contributor.authorHaussen, Diogo C.
dc.contributor.authorSinghal, Aneesh B.
dc.contributor.authorKoroshetz, Walter J.
dc.contributor.authorSmith, Wade S.
dc.contributor.authorNogueira, Raul G.
dc.description.abstractBackground and Purpose-Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS. Methods-The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale was based on items of the National Institutes of Health Stroke Scale (NIHSS) with higher predictive value for LVOS and tested in the Screening Technology and Outcomes Project in Stroke (STOPStroke) cohort, in which patients underwent computed tomographic angiography within the first 24 hours of stroke onset. LVOS were defined by total occlusions involving the intracranial internal carotid artery, middle cerebral artery-M1, middle cerebral artery-2, or basilar arteries. Patients with partial, bihemispheric, and anterior+posterior circulation occlusions were excluded. Receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value of FAST-ED were compared with the NIHSS, Rapid Arterial Occlusion Evaluation (RACE) scale, and Cincinnati Prehospital Stroke Severity (CPSS) scale. Results-LVO was detected in 240 of the 727 qualifying patients (33%). FAST-ED had comparable accuracy to predict LVO to the NIHSS and higher accuracy than RACE and CPSS (area under the receiver operating characteristic curve: FAST-ED=0.81 as referenceen
dc.description.abstractNIHSS=0.80, P=0.28en
dc.description.abstractRACE=0.77, P=0.02en
dc.description.abstractand CPSS=0.75, P=0.002). A FAST-ED >= 4 had sensitivity of 0.60, specificity of 0.89, positive predictive value of 0.72, and negative predictive value of 0.82 versus RACE >= 5 of 0.55, 0.87, 0.68, and 0.79, and CPSS >= 2 of 0.56, 0.85, 0.65, and 0.78, respectively. Conclusions-FAST-ED is a simple scale that if successfully validated in the field, it may be used by medical emergency professionals to identify LVOS in the prehospital setting enabling rapid triage of patients.en
dc.description.affiliationUniv Fortaleza, Ctr Ciencias Saude, Curso Med, Fortaleza, CE, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Dept Neurol, Neurovasc Serv, Sao Paulo, SP, Brazil
dc.description.affiliationBrown Univ, Dept Neurol, Providence, RI USA
dc.description.affiliationEmory Univ, Sch Med, Grady Mem Hosp, Marcus Stroke & Neurosci Ctr,Neuroendovasc & Neur, Atlanta, GA USA
dc.description.affiliationMassachusetts Gen Hosp, Dept Radiol, Boston, MA USA
dc.description.affiliationMassachusetts Gen Hosp, Dept Neurol, Stroke Serv, Boston, MA USA
dc.description.affiliationNINDS, NIH, Bethesda, MD USA
dc.description.affiliationUniv Calif San Francisco, Dept Neurol, Neurovasc Serv, San Francisco, CA USA
dc.description.affiliationUnifespUniv Fed Sao Paulo, Dept Neurol, Neurovasc Serv, Sao Paulo, SP, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipBoehringer Ingelheim
dc.description.sponsorshipStryker Neurovascular-modest
dc.description.sponsorshipIDNIH: R01NS051412
dc.description.sponsorshipIDNIH: P50NS051343
dc.description.sponsorshipIDNIH: R21NS077442
dc.description.sponsorshipIDNIH: R21-NS085574
dc.description.sponsorshipIDNIH: U10NS086729
dc.identifier.citationStroke. Philadelphia, v. 47, n. 8, p. 1997-2002, 2016.
dc.publisherLippincott Williams & Wilkins
dc.rightsAcesso aberto
dc.subjectcerebrovascular occlusionen
dc.subjectstroke, acute, prehospital emergency careen
dc.titleField Assessment Stroke Triage for Emergency Destination A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokesen
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