Face, Arm, Speech, Time Research Articles

Speech disturbance plays critical role in stroke recognition during COVID‐19 pandemic

Speech disturbance plays critical role in stroke recognition during COVID‐19 pandemic

Comparison of eight prehospital stroke scales to detect intracranial large-vessel occlusion in suspected stroke (PRESTO): a prospective observational study

Due to the time-sensitive effect of endovascular treatment, rapid prehospital identification of large-vessel occlusion in individuals with suspected stroke is essential to optimise outcome. Interhospital transfers are an important cause of delay of endovascular treatment. Prehospital stroke scales have been proposed to select patients with large-vessel occlusion for direct transport to an endovascular-capable intervention centre. We aimed to prospectively validate eight prehospital stroke scales in the field. We did a multicentre, prospective, observational cohort study of adults with suspected stroke (aged ≥18 years) who were transported by ambulance to one of eight hospitals in southwest Netherlands. Suspected stroke was defined by a positive Face-Arm-Speech-Time (FAST) test. We included individuals with blood glucose of at least 2·5 mmol/L. People who presented more than 6 h after symptom onset were excluded from the analysis. After structured training, paramedics used a mobile app to assess items from eight prehospital stroke scales: Rapid Arterial oCclusion Evaluation (RACE), Los Angeles Motor Scale (LAMS), Cincinnati Stroke Triage Assessment Tool (C-STAT), Gaze-Face-Arm-Speech-Time (G-FAST), Prehospital Acute Stroke Severity (PASS), Cincinnati Prehospital Stroke Scale (CPSS), Conveniently-Grasped Field Assessment Stroke Triage (CG-FAST), and the FAST-PLUS (Face-Arm-Speech-Time plus severe arm or leg motor deficit) test. The primary outcome was the clinical diagnosis of ischaemic stroke with a proximal intracranial large-vessel occlusion in the anterior circulation (aLVO) on CT angiography. Baseline neuroimaging was centrally assessed by neuroradiologists to validate the true occlusion status. Prehospital stroke scale performance was expressed as the area under the receiver operating characteristic curve (AUC) and was compared with National Institutes of Health Stroke Scale (NIHSS) scores assessed by clinicians at the emergency department. This study was registered at the Netherlands Trial Register, NL7387. Between Aug 13, 2018, and Sept 2, 2019, 1039 people (median age 72 years [IQR 61-81]) with suspected stroke were identified by paramedics, of whom 120 (12%) were diagnosed with aLVO. Of all prehospital stroke scales, the AUC for RACE was highest (0·83, 95% CI 0·79-0·86), followed by the AUC for G-FAST (0·80, 0·76-0·84), CG-FAST (0·80, 0·76-0·84), LAMS (0·79, 0·75-0·83), CPSS (0·79, 0·75-0·83), PASS (0·76, 0·72-0·80), C-STAT (0·75, 0·71-0·80), and FAST-PLUS (0·72, 0·67-0·76). The NIHSS as assessed by a clinician in the emergency department did somewhat better than the prehospital stroke scales with an AUC of 0·86 (95% CI 0·83-0·89). Prehospital stroke scales detect aLVO with acceptable-to-good accuracy. RACE, G-FAST, and CG-FAST are the best performing prehospital stroke scales out of the eight scales tested and approach the performance of the clinician-assessed NIHSS. Further studies are needed to investigate whether use of these scales in regional transportation strategies can optimise outcomes of patients with ischaemic stroke. BeterKeten Collaboration and Theia Foundation (Zilveren Kruis).

The barriers and facilitators to the telephonic application of the FAST assessment for stroke in a private emergency dispatch centre in South Africa.

BackgroundStroke is one of the leading contributors to morbidity and mortality globally. The incidence of stroke is on the increase in Sub-Saharan countries such as South Africa. As stroke is a time-sensitive condition, emergency medical services (EMS) play an important role in the early recognition of stroke. The telephonic application of the FAST (Face, Arm, Speech, Time) assessment has been suggested to screen patients for stroke, but this is not applied consistently. This study aimed to identify the barriers and facilitators to the telephonic application of the FAST assessment.MethodsThis retrospective, exploratory study sampled 20 randomly selected emergency calls to a private EMS in South Africa, with suspected stroke. After verbatim self-transcription, data were analysed using inductive content analysis to identify the barriers and facilitators to the application of the FAST assessment. Results were arranged according to themes.ResultsResults indicated that in 15/20 (75%) of the calls, the FAST assessment was successfully applied. Eight barriers under three themes (practical barriers, emotionality, and knowledge and understanding) and three facilitators under one theme (clear communication) were identified. Most notably, language discordance, lack of empathy and caller frustration featured prominently as barriers while caller cooperation and clear instructions were prominent facilitators.ConclusionWith the barriers known, methods to address these may be constructed. Additional training and credentialing for call-takers may be a reasonable first step. These lessons can likely be applied to other telephonic acuity and recognition algorithms.

Stroke Recognition for First Aid Providers: A Systematic Review and Meta-Analysis.

AimTo perform a systematic review of the literature on the effectiveness of existing stroke recognition scales used in a prehospital setting and suitable for use by first aid providers. The systematic review will be used to inform an update of international first aid guidelines.MethodsWe followed the Cochrane Handbook for Systematic Reviews of Interventions methodology and report results according to PRISMA guidelines. We searched Medline, Embase and CENTRAL on May 25, 2020 for studies of stroke recognition scales used by first aid providers, paramedics and nurses for adults with suspected acute stroke in a prehospital setting. Outcomes included change in time to treatment, initial recognition of stroke, survival and discharge with favorable neurologic status, and increased layperson recognition of the signs of stroke. Two investigators reviewed abstracts, extracted and assessed the data for risk of bias. The certainty of evidence was evaluated using GRADE methodology.ResultsWe included 24 observational studies with 10,446 patients evaluating 10 stroke scales (SS). All evidence was of moderate to very low certainty. Use of the Kurashiki Prehospital SS (KPSS), Ontario Prehospital SS (OPSS) and Face Arm Speech Time SS (FAST) was associated with an increased number of suspected stroke patients arriving to a hospital within three hours and, for OPSS, a higher rate of thrombolytic therapy. The KPSS was associated with a decreased time from symptom onset to hospital arrival. Use of FAST Emergency Response (FASTER) was associated with decreased time from door to tomography and from symptom onset to treatment. The Los Angeles Prehospital Stroke Scale (LAPSS) was associated with an increased number of correct initial diagnoses. Meta-analysis found the summary estimate sensitivity of four scales ranged from 0.78 to 0.86. The FAST and Cincinnati Prehospital Stroke Scale (CPSS) were found to have a summary estimated sensitivity of 0.86, 95% CI [0.69-0.94] and 0.81, 95% CI [0.70-0.89], respectively.ConclusionStroke recognition scales used in the prehospital first aid setting improves the recognition and diagnosis of stroke, thereby aiding the emergency services to triage stroke victims directly down an appropriate stroke care pathway. Of those prehospital scales evaluated by more than a single study, FAST and Melbourne Ambulance Stroke Screen (MASS) were found to be the most sensitive for stroke recognition, while the CPSS had higher specificity. When blood glucose cannot be measured, the simplicity of FAST and CPSS makes these particular stroke scales appropriate for non-medical first aid providers.

FAST 112 HEROES: Patient Engagement in an Educational Stroke Awareness Program for Kindergarten

To engage patients who had a stroke in the past in the FAST 112 Heroes educational program (Tsakpounidou et al. 2019). Patient involvement is an important contribution to improve quality of care and advocacy. As stroke is worldwide a leading cause of disability and mortality (Gurol et al, 2018), individuals who suffered this near death experience are often aware of the stroke symptoms. Unfortunately, studies show that a great percentage of people are not able to recognize the stroke symptoms F.A.S.T. (face, arm, speech, time) (Caminiti et al., 2017; Nikol et al., 2005) and report or call the emergency number.

The accuracy of the FAST stroke assessment in identifying stroke at initial ambulance call into a South African private emergency call centre.

Stroke is a potentially life-threatening, time-dependent event, and one of the leading causes of mortality and lasting morbidity in South Africa (SA). It is of vital importance that Emergency Medical Services (EMS) call-takers accurately recognise stroke symptoms and prioritise time as well as adequate care. EMS call-takers are the first link in stroke care and improving call-taker recognition of stroke signs and symptoms can drastically improve patient outcome. The Newcastle Face Arm Speech Time (FAST) test is a mnemonic aimed at improving diagnostic accuracy of stroke. To assess the use of the FAST test at a call-taker level to raise early suspicion of stroke and appropriately allocate resources to increase awareness of time and decrease delays on scene. A retrospective diagnostic study to determine the accuracy of the FAST mnemonic at identifying stroke when applied at EMS call-taker level. The outcome of the FAST assessment was compared with EMS stroke diagnosis for cases of a private SA EMS over a three-month period (N=146). Using FAST, call-takers were able to identify stroke with a sensitivity of 87.5% and a specificity of 17.4% (positive predictive value 34%, negative predictive value 74%). This yielded an overall accuracy of 40.41%. FAST is a useful screening tool for identifying stroke at call-taker level. FAST has acceptable sensitivity when used as a screening tool; however, specificity and diagnostic effectiveness are lacking. Further studies should be considered to determine call-taker as well as general public knowledge of stroke risk factors and presentation. Stroke is one of the leading causes of death and lasting morbidity in South Africa (SA) and is increasing in incidence. Early recognition of stroke at initial emergency call may expedite treatment, thus improving outcomes. This study demonstrates that the application of the FAST assessment at emergency contact centre level in SA, might be useful at identifying stroke early. Future research should investigate barriers to its use.

Stroke Screening Feature Selection for Arm Weakness Using a Mobile Application

This work studies the features of a proposed automated stroke self-screening application that utilizes the gyroscope and accelerometer devices in smartphones to determine the possible onset of a stroke by assessing arm muscle weakness. The application requires users to perform two arm movements to evaluate arm weakness and pronation: Curl-up and Raise-up. For the purpose of the study, 68 subjects, consisting of 36 stroke patients with symptoms of arm weakness and 32 healthy subjects, consented to participate. A total of 78 handcrafted features were proposed, 26 of which were extracted from Curl-up and Raise-up for each arm. Then, the differences between corresponding features for each arm were calculated. These features were then tested on 63 combinations of three classical feature selection methods, three feature sets (i.e., Curl-up-only features, Raise-up-only features, and both-exercises combined features) and seven well-known classification methods. The results from ten runs of 10-fold cross-validation showed that Curl-up-only features achieved an average sensitivity of 83.3%, significantly higher than those of the Raise-up-only features or both-exercises features. From all possible combinations, the random forest classification based on information gain feature selection from Curl-up-only features achieved the most efficient results for arm-weakness-stroke screening. It achieved an average sensitivity of 94.8%, an average specificity of 75.2%, an average accuracy of 84.1%, and an average area under the receiver operating characteristic curve of 85.0%. Our work proposes a novel accessible method to screen symptoms of arm weakness that may indicate the onset of a stroke using a single mobile device. In the future, we can combine this method with other methods of evaluating facial drooping and slurred speech to create a complete Face, Arm, Speech, Time (FAST) assessment application.

Accuracy of Stroke Diagnosis Using FAST (Face, Arm, Speech, Time) Tool by Emergency Medical Service Dispatchers and Technicians and its Impact on Transport Time

ObjectivesThis study aimed to determine the accuracy of the Face-Arm-Speech-Time (FAST) screening tool used by emergency medical dispatchers (EMDs) and emergency medical technicians (EMTs) for the diagnosis of acute stroke and its effect on the patient’s transfer time from the scene to the hospital.MethodsThis study was conducted retrospectively during a one-year period. Via census sampling, we recruited all patients over 18-years-old diagnosed with acute stroke whether by EMDs or by EMTs. Pre-hospital operation forms and hospital records were used for data gathering. Final diagnoses were finally determined according to the patients’ brain magnetic resonance imaging (MRI).ResultsTotally, 1,280 patients with a mean age of 64.1 ± 17.8 years were studied, of whom, 730 were men (57%). Accordingly, 1,016 probable cases of stroke (79.4%) were reported by EMDs, while only 543 cases (42.4%) were reported as suspected cases of stroke by EMTs at the scene of the incident. Ultimately, stroke was confirmed in 519 (40.5%) cases. Accordingly, the Area under the curves (AUCs) for EMDs and EMTs were 0.50 (0.48 to 0.53) and 0.74 (0.71 to 0.76), respectively. Transport time (TT) was shorter if the initial diagnosis of stroke was made by EMTs. The TT was marginally significant and patients with stroke diagnoses were transported to the hospital faster than others (17.3 ± 11.5 vs. 18.5 ± 11.9 min; P = 0.065).ConclusionsThe use of FAST by EMTs for detecting probable acute stroke has acceptable sensitivity and specificity; but when it is used by EMDs, it has higher sensitivity and very low specificity. The diagnosis of stroke by EMTs may lead to faster transport to the hospital.

Stroke knowledge in underserved Spanish speakers in central California

Race-ethnic disparities in acute stroke care are a major public health problem in the U.S.A. Latinos/Hispanics have higher incidence of stroke, worse outcomes after stroke, and receive less stroke treatment than non-Latino/Hispanic whites. A major barrier to receiving acute stroke treatments is poor stroke knowledge. This study aimed to determine baseline stroke knowledge in Spanish speakers within Central California. 167 Spanish speakers attending health education sessions aimed at underserved Latino/Hispanic Communities completed an 11-question stroke knowledge survey. Approximately 45% reported having middle school education or lower. Most participants (84%) did not recognize the English stroke recognition acronym F.A.S.T. (Face, Arm, Speech, Time). There was a significant relationship between level of education and likelihood of choosing the correct meaning of F.A.S.T. (r = −0.6, p = 0.001). The preferred names for stroke were derrame cerebral (46%) and ataque cerebral (23%). Only 7% chose all five correct stroke signs and symptoms out of eight signs and symptoms of illness. In conclusion, knowledge of common stroke signs and symptoms and of the F.A.S.T. acronym was very low in this population. Future stroke education tools for this population should be simple to understand and should use names for stroke including derrame or ataque cerebral, as the prevailing practice in stroke campaigns of simply using English-Spanish translation of the acronym F.A.S.T. may not be an effective strategy. Culturally-targeted educational tools for increasing stroke knowledge among Spanish-speaking Latinos/Hispanics are urgently needed and will likely improve acute stroke care for this population in the U.S.A. and other Spanish-speaking countries.

Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack.

This is the protocol for a review and there is no abstract. The objectives are as follows: Among the currently validated prehospital stroke scales, what is the diagnostic accuracy of the index tests for the diagnosis of stroke in prehospital screening of patients suspected of having a stroke? To assess the influence of the following potential sources of heterogeneity. Patient demographics (e.g. age, gender). Type of event (transient ischemic attack (TIA), ischemic or hemorrhagic). The definition of TIA used by the study. Level of training of paramedic staff. Items from the methodological quality checklist.

Targets for improving dispatcher identification of acute stroke

Accurate identification of acute stroke by Emergency Medical Dispatchers (EMD) is essential for timely and purposeful deployment of Emergency Medical Services (EMS), and a prerequisite for operating mobile stroke units. However, precision of EMD stroke recognition is currently modest. We sought to identify targets for improving dispatcher stroke identification. Dispatch codes and EMS patient records were cross-linked to investigate factors associated with an incorrect dispatch code in a prospective observational cohort of 625 patients with a final diagnosis of acute stroke or transient ischemic attack (TIA), transported to our stroke center as candidates for recanalization therapies. Call recordings were analyzed in a subgroup that received an incorrect low-priority dispatch code indicating a fall or unknown acute illness (n = 46). Out of 625 acute stroke/TIA patients, 450 received a high-priority stroke dispatch code (sensitivity 72.0%; 95% CI, 68.5-75.5). Independent predictors of dispatcher missed acute stroke included a bystander caller (aOR, 3.72; 1.48-9.34), confusion (aOR, 2.62; 1.59-4.31), fall at onset (aOR, 1.86; 1.24-2.78), and older age (aOR [per year], 1.02; 1.01-1.04). Of the analyzed call recordings, 71.7% revealed targets for improvement, including failure to recognize a Face Arm Speech Time (FAST) test symptom (21/46 cases, 18 with speech disturbance), or failure to thoroughly evaluate symptoms (12/46 cases). Based on our findings, efforts to improve dispatcher stroke identification should primarily focus on improving recognition of acute speech disturbance, and implementing screening of FAST-symptoms in emergency phone calls revealing a fall or confusion. URL: http://www.clinicaltrials.gov . Unique identifier: NCT02145663.

Improved Early Detection of Stroke By FAST Method in Kebraon Village Surabaya

Ignorance of the community about the signs and symptoms of stroke can cause delays of patients stroke be carried to the hospital. FAST (Face, Arm, Speech, Time) is an easy way to identify the symptoms of stroke, causing an increasing number of stroke cases in the community. The purpose of this research is identifying Effect of Health Education about FAST to Knowledge Early Detection of Stroke to The Cadres in Kebraon Village Surabaya.The MethodsThe Design of this research used Pre-experimental with One Group Pretest-Posttest Design approach. The Variable of independent is health education about FAST and the variable of dependent is knowledge early detection of stroke. The number population of health cadre in Kebraon Village is 164 people used Simple random sampling techniques as much as 116 respondents health cadres. The instrument used a questionnaire sheet. Data were analyzed with the Wilcoxon signed rank test.The results showed before being given health education about FAST, the knowledge of cadres majority is deficient. But after being given a health education about FAST, the knowledge of cadres majority is good. Wilcoxon signed rank test indicated the value of health education about FAST to knowledge early detection of stroke ρ = 0.000 ≤ α = 0.05. Conclusion The implication result of the this research showed an enhancement knowledge of early detection of stroke on cadres. Be expected enhancement knowledge to community about early detection of stroke with FAST.Keywords: FAST, Knowledge of Early Detection of Stroke, Cadres

Temporal Trends in Emergency Medical Services and General Practitioner Use for Acute Stroke After Australian Public Education Campaigns.

Background and Purpose- The Australian Stroke Foundation ran annual paid advertising between 2004 and 2014, using the FAST (Face, Arm, Speech, Time) campaign from 2006 and adding the message to call emergency medical services in 2007. In this study, we examined temporal trends in emergency medical services use and referrals from general practitioners in the Australian state of Victoria to evaluate the impact of these campaigns. Methods- Using data from 33 public emergency departments, contributing to the Victorian Emergency Minimum Dataset, we examined trends in emergency department presentations for 118 000 adults with an emergency diagnosis of stroke or transient ischemic attack between 2003 and 2015. Annual trends were examined using logistic regression using a precampaign period (January 2003 to August 2004) as reference and adjusting for demographic variables. Results- Compared with the precampaign period, significant increases in emergency medical services use were seen annually between 2008 and 2015 (all P<0.001, eg, 2015; adjusted odds ratio, 1.16; 95% CI, 1.10-1.23). In contrast, a decrease was seen in patients presenting via general practitioners across all campaign years (all P<0.001, eg, 2015; adjusted odds ratio, 0.48; 95% CI, 0.44-0.53). Conclusions- Since the Stroke Foundation campaigns began, a greater proportion of stroke and transient ischemic attack patients are presenting to hospital by emergency medical services and appear to be bypassing their general practitioners.

Community-Based Stroke Recognition Education and Response: An Evidence-Based Intervention Project.

Stroke has a significant impact on mortality and disability in the United States. This led the aforementioned master's students to create a community-based educational intervention using stroke curriculum from the American Heart Association/American Stroke Association (AHA/ASA). The purpose of this evidence-based intervention project was to examine the effectiveness of public stroke education utilizing the AHA/ASA's Face, Arm, Speech, Time (FAST) curriculum for stroke symptom recognition and response (Jauch, et al., 2013) at three central Connecticut senior centers. This evidence-based intervention project was based on the theoretical framework of Dorothea Orem's Self-Care Deficit Theory (Petiprin, 2016). Nurses can provide stroke based education to older adults in the community, ultimately empowering participants to recognize and respond to stroke symptoms. An educational session on the AHA/ASA FAST curriculum was presented by master's students to groups of senior adults at three different senior centers, followed by a post teach-back session conducted by the students in smaller groups to assess learning. The total number of participants was 62 (n = 62). The majority of participants (87%) were able to accurately teach back the four components of the FAST curriculum after the educational intervention. FAST was simple to teach and engaging for participants. Using the FAST curriculum in senior center populations increased the participants' awareness of stroke signs and symptoms, and their willingness to activate the 911 emergency system. Educational interventions in the community with older adults can produce increased awareness of stroke symptoms and willingness to respond when necessary.

Evaluation of a score for the prehospital distinction between cerebrovascular disease and stroke mimic patients.

Patients with a sudden onset of focal neurological deficits consistent with stroke, who turn out to have alternative conditions, have been labeled stroke mimics. We assessed a recently validated telemedicine-based stroke mimic score (TeleStroke mimic score; TM-score) and individual patient characteristics with regard to its discriminative value between cerebrovascular disease and stroke mimic patients in the in-person, pre-hospital setting. We evaluated patients cared for in a mobile stroke unit in Berlin, Germany. We investigated whether the TM-score (comprising six parameters), Face Arm Speech Time test, and individual patient characteristics were able to differentiate cerebrovascular disease from stroke mimic patients. We included 423 patients (299 (70.7%) cerebrovascular disease and 124 (29.3%) stroke mimic) in the final analysis. A TM-score > 30 indicated a high probability of a cerebrovascular disease and a score ≤15 of a stroke mimic. The TM-score performed well to identify stroke mimics (area under the curve of 0.74 under receiver-operating characteristic curve analysis). The cerebrovascular disease patients were older (74.8 vs. 69.8 years, p = 0.001), had more often severe strokes (NIHSS > 14 25.8% vs. 11.3%, p = 0.001), presented more often with weakness of the face (70.9% vs. 42.7%, p = 0.001) or arm (60.9% vs. 33.9%, p = 0.001), dysarthria (59.5% vs. 40.3%, p < 0.001), history of atrial fibrillation (38.1% vs. 21.0%, p = 0.001), arterial hypertension (78.9% vs. 53.2%, p < 0.001), and less often with seizure (0.7% vs. 21.0%, p < 0.001). The TM-score and certain patient characteristics can help paramedics and emergency physicians in the field to identify stroke mimic patients and select the most appropriate hospital destination.

Medical Attention Seeking After Transient Ischemic Attack and Minor Stroke Before and After the UK Face, Arm, Speech, Time (FAST) Public Education Campaign

Risk of major stroke is high during the hours and days after transient ischemic attack (TIA) and minor stroke but is substantially reduced by urgent medical treatment. Public education campaigns have improved the response after major stroke, but their association with behavior after TIA and minor stroke is uncertain. The number of potentially preventable early recurrent strokes in patients who delay or fail to seek medical attention is unknown. To investigate the association of public education with delays and failure in seeking medical attention after TIA and minor stroke. Prospective population-based study of all patients with TIA or stroke who sought medical attention between April 1, 2002, and March 31, 2014, registered at 9 general practices in Oxfordshire, United Kingdom. Data analysis took place from July 1, 2013, to March 2, 2015. Face, Arm, Speech, Time (FAST) public education campaign in the United Kingdom. Number of early recurrent strokes in patients who delayed or failed to seek medical attention, as well as the odds of seeking urgent attention after TIA and minor stroke before vs after initiation of the public education campaign. Among 2243 consecutive patients with first TIA or stroke (mean [SD] age, 73.6 [13.4] years; 1126 [50.2%] female; 96.3% of white race/ethnicity), 1656 (73.8%) had a minor stroke or TIA. After the FAST campaign, patients with major stroke more often sought medical attention within 3 hours (odds ratio [OR], 2.56; 95% CI, 1.11-5.90; P = .03). For TIA and minor stroke, there was no improvement in use of emergency medical services (OR, 0.79; 95% CI, 0.50-1.23; P for interaction = .03 vs major stroke) or time to first seeking medical attention within 24 hours (OR, 0.75; 95% CI, 0.48-1.19; P for interaction = .006 vs major stroke). Patient perception of symptoms after TIA and minor stroke was associated with more urgent behavior, but correct perception declined after the FAST campaign (from 37.3% [289 of 774] to 27.6% [178 of 645]; OR, 0.64; 95% CI, 0.51-0.80; P < .001). One hundred eighty-eight patients had a stroke within 90 days of their initial TIA or stroke, of whom 93 (49.5%) followed unheeded TIAs for which no medical attention was sought, similar before and after the FAST campaign (43 of 538 [8.0%] before vs 50 of 615 [8.1%] after, P = .93). This study suggests that in contrast to major stroke, extensive FAST-based public education has not improved the response to TIA and minor stroke in the United Kingdom, emphasizing the need for campaigns that are tailored to transient and less severe symptoms.

Abstract TP250: The Stroke 1-2-0 Strategy is Well Accepted by Community Physicians in China

Background: While FAST (Face, Arm, Speech, Time) has been used in China for stroke awareness and rapid response education, however, the effectiveness is unclear due to the language barrier, and the stroke related mortality remains very high. We recently engineered Stroke 1-2-0 for China based on FAST.[1] This investigation aimed to investigate its acceptance in community physicians. Method: This investigation protocol was approved by the Institutional Review Board of the Minhang Hospital affiliated to Fudan University. Questionnaire is distributed to community physicians or family doctors (total of 247 physicians). An educational session was planned to teach both FAST and Stroke 1-2-0 for the participants before and after educational session to evaluate the awareness of stroke, stroke recognition tool and the acceptance of the stroke recognition tool. Results: In educational sessions consisting of 247 family physicians (82 male and 165 female), 98.79% of the survey responders are at the age range of 21-60 years old in two major cities (Shanghai and Hangzhou). Only 10.53% of the participants know that the thrombolytic therapeutic window is 4.5 hours. 28.74% of the participants select time points more than 4.5 hours. Only small portion of physicians in the community know FAST (36.44%) or Stroke 120 (39.27%) as a stroke recognition tool. After the training session, majority of the participants understand that the therapeutic window for ischemic stroke is 4.5 hr as compared to a small portion before the educational session (10.53%). Majority of the participants mastered Stroke 1-2-0 (98.79%) and FAST (98.79%) immediately after the training session. However, 97.17% of the participants believe that Stroke 1-2-0 is the most suitable program in China in stroke education. Only seven participants believe that FAST is a still better tool for Chinese. Conclusion: While community physician play critical role in patient education, a significant knowledge deficiency for stroke awareness is identified. Despite both Stroke 120 and FAST can be mastered easily by community physician, they believe Stroke 1-2-0 should be used for stroke awareness education and rapid action for the public domain in China.

Impact of the Swedish National Stroke Campaign on stroke awareness.

Time delay from stroke onset to arrival in hospital is an important obstacle to widespread reperfusion therapy. To increase knowledge about stroke, and potentially decrease this delay, a 27-month national public information campaign was carried out in Sweden. To assess the effects of a national stroke campaign in Sweden. The variables used to measure campaign effects were knowledge of the AKUT test [a Swedish equivalent of the FAST (Face-Arm-Speech-Time)] test and intent to call 112 (emergency telephone number) . Telephone interviews were carried out with 1500 randomly selected people in Sweden at eight points in time: before, three times during, immediately after, and nine, 13 and 21months after the campaign. Before the campaign, 4% could recall the meaning of some or all keywords in the AKUT test, compared with 23% during and directly after the campaign, and 14% 21months later. Corresponding figures were 15%, 51%, and 50% for those remembering the term AKUT and 65%, 76%, and 73% for intent to call 112 when observing or experiencing stroke symptoms. During the course of the campaign, improvement of stroke knowledge was similar among men and women, but the absolute level of knowledge for both items was higher for women at all time points. The nationwide campaign substantially increased knowledge about the AKUT test and intention to call 112 when experiencing or observing stroke symptoms, but knowledge declined post-intervention. Repeated public information therefore appears essential to sustain knowledge gains.

Correction to: Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry).

HomeStrokeVol. 48, No. 3Correction to: Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry) Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry) Originally published1 Mar 2017https://doi.org/10.1161/STR.0000000000000123Stroke. 2017;48:e95This article corrects the followingClinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel OcclusionIn the article by Scheitz et al, “Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry),” which published online ahead of print January 13, 2017, and appears in the February 2017 issue of the journal (Stroke. 2017;48:290–297. DOI: 10.1161/STROKEAHA.116.014431), a correction is needed.On page 290, in the Abstract, the sentence read “Addition of abnormal gaze–face–arm–speech–time (G-FAST) or high scores on other simplified stroke scales increased specificity,” has been changed to read “Addition of the item best gaze to the original FAST score (G-FAST) or high scores on other simplified stroke scales increased specificity.”On page 290, the correspondence E-mail address read “[email protected],” has been changed to read “[email protected]”On page 291, right column, fourth line read “Because the NIHSS item best gaze is missing in the typical FAST algorithm but strongly associated with LAVO,21,26–28 we tested the hypothesis that adding the abnormal gaze–face–arm–speech–time (G-FAST) may improve its predictive value,” has been changed to read “Because the NIHSS item best gaze is missing in the typical FAST algorithm but strongly associated with LAVO,21,26–28 we tested the hypothesis that adding the item best gaze to FAST (G-FAST) may improve its predictive value.”This correction has been made to the current online version of the article, which is available at http://stroke.ahajournals.org/content/48/2/290. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesClinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel OcclusionJan F. Scheitz, et al. Stroke. 2017;48:290-297 March 2017Vol 48, Issue 3 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/STR.0000000000000123PMID: 28242807 Originally publishedMarch 1, 2017 PDF download Advertisement

Outpatient management of transient ischaemic attack.

Stroke is a significant cause of death and disability in Singapore; in 2014, it was the fourth most common cause of death. Transient ischaemic attack (TIA) is defined as a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without evidence of acute infarction. The diagnosis of TIA/acute stroke needs to be considered in all patients who present with sudden focal neurological dysfunction. Prompt referral for assessment, neuroimaging and intervention provides the best chance for neurological recovery and/or minimising further neurological damage. Primary care physicians have a crucial role in TIA/stroke prevention and management. This includes referring patients with suspected acute TIA/stroke to hospitals with stroke treatment facilities immediately; managing the modifiable risk factors of cerebral ischaemia; continuing prescription of antiplatelet agents and/or anticoagulation where indicated; and teaching patients to recognise and respond to suspected cerebral ischaemia using the FAST (face, arm, speech, time) acronym.