Abstract
The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score was developed in the hospital setting to be used in the prehospital setting. It has been shown to have higher predictive value than comparable stroke scales, including the National Institutes of Health Stroke Scale, for identifying large vessel occlusion strokes. We sought to determine whether prehospital FAST-ED scores are comparable with FAST-ED scores determined by emergency physicians. Emergency Medical Services (EMS) personnel were trained to calculate a FAST-ED score for any patient suspected of having a stroke in the field. When the patient arrived at our ED, an emergency physician generated a FAST-ED score. One hundred and thirty-five patients were studied and large vessel occlusions were detected in 23.7%. There was no significant difference between median FAST-ED scores from EMS personnel (3; interquartile range [IQR] 1-5) and emergency physician (2; IQR 1-6). The difference between paired scores was not significantly different from 0 (median of paired differences was 0). In addition, prehospital FAST-ED scores were significantly and positively correlated with physician FAST-ED scores (r2=0.26). Comparable receiver operator curve area under the curve values were obtained for EMS FAST-ED (0.727; 95% confidence interval [CI] 0.638-0.816) and ED FAST-ED (0.769; 95% CI 0.669-0.868). The findings validate that prehospital FAST-ED scores are comparable in predictive value to FAST-ED scores calculated in the ED for prediction of large vessel occlusion strokes.
Highlights
Background and ObjectiveIdentification of elderly trauma patients who are likely to have poor outcome may help the emergency physician to provide better management
We performed a univariate logistic regression to select the best predictors of mortality at 28 days, which were reduced to three in multivariable logistic regression: the C-reactive protein (CRP) test with an odds ratio (OR) at 1.01 and confidence interval (CI) 95%, 1.00 – 1.01, p = 0.05; the Index Severity Score (ISS) face with an OR at 2.24 and CI 95%, 1.12 – 4,47, p = 0,02; and the hospitalization rate with an OR at 1.71 and CI 95%, 1.07 – 2.72, p = 0.02
CRP, the ISS face, and being hospitalized appear to predict poor outcome in elderly traumatic patients admitted in the emergency department (ED)
Summary
Miami-Dade County emergency medical services (EMS) personnel were trained to calculate a FAST-ED score for any patient suspected of having an ischemic stroke or transient ischemic attack in the field (EMS FAST-ED). When the patient arrived in the ED of a comprehensive stroke center a physician completed a FAST-ED score (ED FAST-ED). Imaging was taken in accordance with hospital stroke guidelines. We excluded from the study intracranial hemorrhages seen on the non-contrast brain computed tomography. LVOS were defined as complete or partial occlusion of the internal carotid artery, middle cerebral artery, and basilar artery
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