Face, Arm, Speech, Time Research Articles

Calling for a rapid recognition and response program for stroke in China

In this article, we provide evidences indicating that a a rapid recognition and response program based on FAST (face, Arm, Speech, Time) for stroke suitable for China is desperately needed.

Abstract WMP70: Accuracy of Emergency Dispatcher Stroke Recognition When Employing a Stroke Screening Tool: A Systematic Review

Introduction: Emergency dispatchers are usually the first contact point for stroke patients accessing the healthcare system. Dispatcher stroke recognition is associated with better paramedic stroke recognition and faster emergency medical services (EMS) response time, but stroke is often unrecognized during the initial call. We conducted a systematic review to quantify the accuracy of emergency dispatcher stroke recognition when employing stroke screening tools. Methods: We conducted a comprehensive search Medline, EMBASE, CINAHL, and Cochrane databases to identify studies of dispatcher stroke recognition accuracy using a stroke screening tools such as the Medical Priority Dispatch System (MDPS) or Face Arm Speech Time (FAST) mnemonic. Studies were included if they reported dispatcher sensitivity or positive predictive value (PVP) using hospital stroke/TIA diagnosis as the gold standard. Study quality was assessed using QUADAS 2. Two independent reviewers determined study eligibility, assessed quality, and abstracted data. Results: We identified 1450 abstracts; seven cohort studies met inclusion criteria. Stroke screening tools included MPDS (n=4), FAST (n=2), and a novel screening algorithm (n=1). The sensitivity of dispatcher stroke recognition (5 studies, range 41-83%) and PPV (7 studies, range 42% -68%) were variable. Specificity was high (3 studies, 95-99%). No screening tool demonstrated superiority. Included studies had moderate risk of bias and dramatically variable stroke prevalence (range 3-68%). Conclusion: Published reports of screening tools utilized by emergency dispatchers demonstrate suboptimal sensitivity and PPV. More research is needed to identify the causes of poor dispatcher stroke recognition and to improve stroke screening tools.

Organizational Update: American Stroke Association Stroke Council Update.

In this semiannual update, we will focus on a major American Heart Association/American Stroke Association (AHA/ASA) initiative to improve its educational programming and changes to the process for developing guidelines and scientific statements. In addition, there are updates on research funding and the upcoming International Stroke Conference (ISC). Before the updates, we will first review the AHA/ASA mission and goals and the role of the stroke council. The mission of the AHA/ASA is to build healthier lives, free of cardiovascular diseases and stroke. The current goal is, by the year 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths caused by cardiovascular diseases and stroke by 20%. The AHA/ASA aims to achieve these goals by (1) providing knowledge-based solutions for people of all ages at all levels of risk, (2) leading efforts for research, prevention, and treatment, and (3) serving the cardiovascular and stroke health needs of all people living in the United States as a partner of choice for researchers, systems, providers, and consumers. The stroke council is one of the 16 AHA/ASA councils and provides scientific input and support to the organization in pursuit of these goals. Stroke council volunteers help advance the AHA/ASA mission through many different activities. This includes the dissemination of new knowledge through the Stroke journal, the development and promulgation of evidence-based treatment guidelines and scientific statements, and through scientific meetings (primarily the ISC). The stroke council advises the AHA/ASA in their efforts for advocacy for stroke research funding, public policy, and community education (like the television ads for early stroke recognition—Face Arm Speech Time). The development of primary and comprehensive stroke center certification by the Joint Commission was due in a large …

Sustained impact of UK FAST-test public education on response to stroke: a population-based time-series study.

BackgroundUrgent assessment is essential after stroke. Several countries have had public education campaigns, based on the FAST (Face-Arm-Speech-Time) test to reduce delays in seeking attention. However, the impact of these campaigns on patient behavior is uncertain.MethodsWe prospectively determined patient behavior after incident major stroke (NIHSS > 3) in a UK population based study (Oxford Vascular Study) before (2002–2008) and after (2009–2013) introduction of the FAST TV-campaign and assessed any sustained impact of campaign continuation.ResultsAmong 668 consecutive patients with major stroke, medical attention was sought by a bystander in 553 (89·6%). Patients were more likely to present directly to emergency services (OR = 2·18, 95%CI:1·54–3·09, P < 0·0001) after the campaign and to arrive at hospital within 3 h (OR = 2·18, 1·55–3·06, P < 0·0001). Median [IQR] time to seeking attention fell from 53 [15–265] to 31 [7–120] minutes (P = 0·005) and median time to hospital arrival from 185 [88–885] to 119 [78–256] minutes (P < 0·0001). On time-series analysis improvements in hospital arrival within 3 h and use of emergency medical services were significantly associated to initiation of the campaign (aOR = 3·11, 1·53–6·29, P = 0·002; and 2·22, 1·05–4·67, P = 0·036, respectively), independent of trend, age, sex, ethnicity, educational level, social class, prior stroke and stroke severity, and have been sustained to 2013.ConclusionDelays to seeking and receiving medical attention after major stroke in the UK. fell strikingly in 2009, coinciding with the start of the FAST TV campaign. That medical attention was sought by a bystander in nearly 90% of cases illustrates the importance of mass-media public education rather than focused programs in high-risk groups for major stroke.

UK university students’ awareness of stroke early warning signs and the FAST campaign

Background: The UK FAST (face, arm, speech, time) campaign aimed to increase awareness of stroke early warning signs (EWS) and the need to call 999. Research is needed to investigate the impact of this campaign among UK allied health professional (AHP) students and university students in general. Methods: Ethical approval was obtained from the university. A sample of 291 university students completed an online pilot questionnaire. Data regarding awareness of EWS, thrombolysis, the FAST campaign and the need to call 999 were collected, coded and analysed using descriptive statistics and independent sample t tests, a Mann-Whitney U test and multiple regression analyses. Results: Two thirds of students were aware of the FAST campaign, and the majority could name all four letters (48%). Overall, 62% could name 3 EWS and 94% knew to call 999. Awareness of the FAST campaign, being aged over 20 years and awareness of thrombolysis were significant predictors of greater EWS knowledge (P&lt;0.001); however, firstaid training and personal experience of stroke were not. AHP students had significantly greater stroke awareness compared to non-AHP students. Conclusions: This study reports fairly good knowledge of stroke, suggesting the FAST campaign appears to have been somewhat successful in raising awareness within this sample. Opportunities exist for further development of knowledge, particularly the breadth of EWS known by AHP students. Implications: Stroke education in this population needs to be developed further to ensure sufficient knowledge as future potential bystanders and for AHP students as future healthcare professionals. Further research is warranted.

Face Arm Speech Time Test Use in the Prehospital Setting, Better in the Ambulance than in the Emergency Medical Communication Center

Background: Prehospital identification of acute stroke increases the possibility of early treatment and good outcome. To increase identification of stroke, the Face Arm Speech Time (FAST) test was introduced in the Emergency Medical Communication Center (EMCC). This substudy aims to evaluate the implementation of the FAST test in the EMCC and the ambulance service. Methods: The study was conducted in the region of Stockholm, Sweden during 6 months. The study population consisted of all calls to the EMCC concerning patients presenting at least one FAST symptom or a history/finding making the EMCC or ambulance personnel to suspect stroke within 6 h. Positive FAST was compared to diagnosis at discharge. Positive predictive values (PPV) for a stroke diagnosis at discharge were calculated. Results: In all, 900 patients with a median age of 71 years were enrolled, 667 (74%) by the EMCC and 233 (26%) by the ambulances. At discharge, 472 patients (52%) were diagnosed with stroke/transient ischemic attack (TIA), 337 identified by the EMCC (71%) and 135 (29%) by the ambulances. The PPV for a discharge diagnosis of stroke/TIA was 51% (CI 47-54%) in EMCC-enrolled and 58% (CI 52-64%) in ambulance-enrolled patients. With a positive FAST the PPV of a correct stroke/TIA diagnosis increased to 56% (CI 52-61%) and 73% (CI 66-80%) in EMCC- and ambulance-enrolled patients, respectively. Positive FAST from EMCC was also found in 44% of patients with a nonstroke diagnosis at discharge. A stroke/TIA diagnosis at discharge but negative FAST was found in 58 and 27 patients enrolled by the EMCC and ambulances, respectively. Conclusions: The PPV of FAST is higher when used on the scene by ambulance than by EMCC. FAST may be a useful prehospital tool to identify stroke/TIA but has limitations as the test can be negative in true strokes, can be positive in nonstrokes, and FAST symptoms may be present but not identified in the emergency call. For the prehospital care situation better identification tools are needed.

Abstract T P325: Parental Knowledge in Childhood Arterial Ischemic Stroke

Objective: Recognizing stroke symptoms and taking appropriate action are vital first steps in stroke care in adults but data are lacking in children. Our objective was to describe stroke knowledge and care seeking behaviour in parents of children presenting to the Emergency Room with stroke. Methods: Structured parental interview to determine stroke symptom knowledge. Event driven process modeling and value focused engineering were used to select questions with the fundamental objectives being correct recognition of stroke symptoms and correct action (call 911). The Stroke Action Test (STAT), a validated instrument with stroke scenarios was used to determine care seeking behaviour; 21 items are stroke specific. The correct response is to call 911. Results: A total of 34 parents were interviewed. The most common unprompted stroke symptoms given were limb (94%) or face weakness (78%) and speech disturbance (66%). 14 (41%) of parents remembered at least one item of the Face Arm Speech Time (FAST) acronym. 8 (24%) could remember all 4 items. Prompted recognition of AHA SUDDENS symptoms (yes I would think of stroke) included face (88%) or limb (77%) numbness/weakness, confusion/speech problems (77%), trouble walking/incoordination (47%), visual symptoms (35%) and headache (38%). 26 (77%) of parents knew of stroke treatments; 37% were aware of anti-thrombotic treatments but only 12% were aware of thrombolysis. Median STAT score was 10 (IQR 6-14), meaning parents called 911 for 48% of stroke scenarios. Questions with &gt;1 symptom (focal weakness and speech disturbance) had highest correct responses (84%) and visual disturbance or dizziness had the lowest correct responses (12.5%). Conclusions: Parental knowledge varies across stroke symptoms and care seeking behaviour is suboptimal. Few parents are aware of thrombolysis. Initiatives to link knowledge to appropriate action are urgently needed if children are to receive the benefits of hyper-acute therapies.

CONTRASTING IMPACT OF FAST–TEST PUBLIC EDUCATION ON BEHAVIOUR AFTER TIA AND MINOR STROKE VERSUS MAJOR STROKE: A POPULATION–BASED STUDY

BackgroundFast medical assessment is essential after TIA and stroke. Several countries have had out public education campaigns to increase symptom recognition and reduce delays in seeking medical attention. However, since...

Can a media campaign change health service use in a population with stroke symptoms? Examination of the first Irish stroke awareness campaign

BackgroundMass media campaigns for stroke awareness encourage the public to recognise stroke symptoms and respond to stroke in a timely manner. However, there is little evidence to suggest that media...

Interaction between time to treatment and reperfusion therapy in patients with acute ischemic stroke

‘Time is brain’ is a slogan that has been used by stroke advocacy groups to raise public awareness that stroke is a medical emergency which requires timely treatment.1 Similarly, the...

Diagnostic confusion resolved by being upbeat

The classical stroke presentation – captured by the public health campaign mnemonic FAST (face, arm, speech, time) – does not apply in a large number of stroke cases; yet establishing a prompt diagnosis is imperative for optimal management. Here, we describe a patient with acute bulbar weakness, numbness in all extremities and an apparently normal magnetic resonance imaging (MRI) of the brain upon admission for whom even the fundamental question of whether this reflected a central or peripheral nervous system process was unclear. The critical localizing sign was upbeat nystagmus that denotes a brainstem cause. MRI of the brain in the second week confirmed a diagnosis of medial medullary infarction.

Abstract 3024: School is Out : Creating Stroke Detectives through Summer Challenge

Background: Childhood obesity and early-onset diabetes are on the rise. The American Heart Association Heart Disease and Stroke Statistics indicate that the unhealthy behaviors that are the risk factors for stroke begin with school-aged children. In 2009, our organization created a stroke awareness program for high schools and youth groups that demonstrated retention of knowledge in a pre-post test format. The content was developed to be relevant for that specific age group. Purpose: Building on that success and the need for earlier education, we developed a Stroke Detective Summer Challenge for elementary age children. Method: This independent, structured program was made available through the stroke center website. Packets were also placed at three local libraries and provided to 3 rd graders at a local summer day camp. The program content included the stroke detective pledge (written by the stroke program coordinator), an activity book, an exercise &amp; healthy eating log, and a scavenger hunt. To qualify as a stroke detective, participants were required to: 1) sign the pledge; 2) share their stroke knowledge with 5 people by giving them a F.A.S.T. (face, arm, speech, time) card and getting their signatures; and 3) return the signature page along with their completed exercise &amp; healthy eating log and their T-shirt size. Results: A summer’s end celebration for the 22 new “stroke detectives” included stations for making a healthy snack and for some simple physical activity competitions. They each received a detective bag, healthy snack recipes, giveaways, and a Stroke Detective T-shirt. These young detectives, along with their parents and siblings were greeted by our hospital mascot and were given a tour of our helicopter. The students, supported by their parents, enthusiastically described their pride in becoming stroke detectives. Conclusions: Our previous successful experience with making educational content relevant for specific age groups was repeated in this unique initiative. We demonstrated that stroke awareness education does NOT have to be complex or scary; in fact, by introducing simple facts at a young age, we may help eliminate the fear and ignorance that has made community awareness of stroke such a challenge in the past. They could become the first generation of adults to know that a stroke does not occur in the heart.

Stroke Public Awareness Campaigns Have Increased Ambulance Dispatches for Stroke in Melbourne, Australia

Launch of the National Stroke Foundation stroke awareness campaigns has occurred annually during Stroke Week (September) since 2004. From 2006, the campaign used FAST (Face, Arm, Speech, Time) with calling an ambulance added in 2007. The aim of this study was to explore the impact of these campaigns on ambulance dispatches for stroke (Medical Priority Dispatch Card 28) in Melbourne, Australia. A cross-sectional study examining the monthly proportions of ambulance dispatches for stroke between August 1999 and 2010 was conducted. The proportions of dispatches for stroke were used due to increases in the population and in ambulance dispatches over the study period. These proportions were statistically compared for the month before Stroke Week (August) and the month after Stroke Week (October) for each year and seasonal variation was examined. Between 1999 and 2009, the annual proportion of dispatches for stroke increased from 2.1% (n=4327) to 2.95% (n=9918). When stroke dispatches in August were compared with those in October, a significant increase in October was only detected since the call an ambulance message was added to FAST: 2007 (2.62% to 3.00%, P=0.006), 2008 (2.62% to 3.05%, P=0.003), and 2009 (2.70% to 3.09%, P=0.007). From 2005, the peak season for stroke dispatches shifted from winter to spring. Ambulance dispatches for stroke significantly increased after the National Stroke Foundation campaigns began, particularly in years receiving greater funding and featuring the FAST symptoms and the message to call an ambulance. Monitoring ambulance use appears to be an effective measure of campaign penetration.

Designing a Message for Public Education Regarding Stroke

Previous studies have shown poor public knowledge of stroke warning signs. The current public education message adopted by the American Heart Association lists 5 stroke warning signs ("suddens"). Another message called FAST (face, arm, speech, time) could be easier to remember, but it does not contain as many stroke symptoms. We sought to assess the percentage of stroke/transient ischemic attack (TIA) patients identified by both public awareness messages by examining presenting symptoms of all stroke/TIA patients from a large, biracial population in 1999. Cases of stroke who presented to an emergency department or were directly admitted were ascertained at all local hospitals by screening of ICD-9 codes 430 to 436, and prospective screening of emergency department admission logs, in 1999. Study nurses abstracted initial presenting symptoms from the medical record. All-cause 30-day case-fatality was calculated. During 1999, 3498 stroke/TIA patients (17% black, 56% female) presented to an emergency department. Of these events, 11.1% had presenting symptoms not included in FAST, whereas 0.1% had presenting symptoms not included in the suddens. The FAST message performed much better for ischemic stroke and TIA than for hemorrhage, missing 8.9% of the ischemic strokes and 8.2% of the TIAs, versus 30.6% of intracerebral hemorrhage/subarachnoid hemorrhage cases. Case-fatality in patients missed by FAST was similar to patients with FAST symptoms (9.0% versus 11.6%, P=0.15). Within our population, we found that the FAST message identified 88.9% of stroke/TIA patients. The FAST message performed better for ischemic stroke and TIA than for hemorrhagic stroke. Whether the FAST message is easier to recall for the public than the "suddens" message has yet to be determined.