Effect of using G-FAST to recognize emergent large vessel occlusion: A city-wide community experience

Abstract

A prehospital bypass strategy was suggested for large vessel occlusion. This study aimed to evaluate the effect of a bypass strategy using the gaze-face-arm-speech-time test (G-FAST) implemented in a metropolitan community. Pre-notified patients with positive Cincinnati Prehospital Stroke Scale and symptom onset <3h from July 2016 to December 2017 (pre-intervention period) and those with positive G-FAST and symptom onset <6h from July 2019 to December 2020 (intervention period) were included. Patients aged <20 years and those with missing in-hospital data were excluded. The primary outcomes were the rates of receiving endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT). The secondary outcomes were total prehospital time, door-to-computed tomography (CT) time, door-to-needle (DTN) time, and door-to-puncture (DTP) time. We included 802 and 695 pre-notified patients from the pre-intervention and intervention periods, respectively. The characteristics of the patients in the two periods were similar. In the primary outcomes, pre-notified patients during the intervention period showed higher rates of receiving EVT (4.49% vs. 15.25%, p<0.001) and IVT (15.34% vs. 21.58%, p=0.002). In the secondary outcomes, pre-notified patients during intervention period had longer total prehospital time (mean 23.38 vs 25.23min, p<0.001), longer door-to-CT time (median 10 vs 11min, p<0.001), longer DTN time (median 53 vs 54.5min, p<0.001) but shorter DTP time (median 141 vs 139.5min, p<0.001). The prehospital bypass strategy with G-FAST showed benefits for stroke patients.