Abstract

BACKGROUND: Use of prehospital stroke scales may enhance stroke detection and improve treatment rates and delays. Current scales, however, may lack detection accuracy. As such, we examined if coordination and diplopia (Balance and Eyes) assessments increase the accuracy of the Face-Arms-Speech-Time (FAST) scale in a multi-site prospective study of emergency response activations for presumed stroke.METHODS: This was a prospective study of emergency response activations for presumed stroke in Santa Clara County, California. Emergency medical responders were trained in the BEFAST scale and administered the scale on scene to all patients who were within 6hours of onset of neurological symptoms. Patient's final diagnosis (stroke vs no stroke) was based on review of hospital records. We compared the performance of the BEFAST and FAST scales for stroke detection.RESULTS: Three hundred fifty-nine patients were included in our analysis. Compared to non-stroke patients (n=200), stroke patients (n=159) more often scored positive on each of the five elements of the BEFAST scale (p<0.05 for each). In multivariable analysis, only facial droop and arm weakness were independent predictors of stroke (p<0.05). BEFAST and FAST scale accuracy for stroke identification was comparable (AUC=0.70 vs. AUC=0.69, p=0.36). Optimal cutoff for stroke detection was =1 for both scales. At this threshold, the PPV was 0.49 for the BEFAST and 0.53 for the FAST scale, and NPV was 0.93 for BEFAST and 0.86 for FAST.CONCLUSION: Adding coordination and diplopia assessments to face, arm, and speech assessment does not improve stroke detection in the prehospital setting.

View details for DOI 10.1080/10903127.2018.1490837

View details for PubMedID 30118372