From the Clinical Audit and Research Unit, London Ambulance Service National Health Service (NHS) Trust, London, United Kingdom (R.T.F., M.J.E.); School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom (J.W.); College of Medicine, Swansea University, Swansea, United Kingdom (I.T.R.); and Royal London Hospital, Barts Health NHS Trust, London, United Kingdom (P.G.).
Stroke. 2013 Nov;44(11):3007-12. doi: 10.1161/STROKEAHA.13.000851. Epub 2013 Sep 26.
U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition.
Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses.
Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke.
The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.
英国的救护车服务机构使用“面臂言语测试（FAST）”来评估疑似中风的患者。“急诊室识别中风（ROSIER）”工具在识别急诊科中的中风方面优于 FAST，但之前并未在救护车环境中进行过测试。我们调查了救护车临床医生使用 ROSIER 是否可以提高中风识别率。
救护车临床医生使用 ROSIER 替代 FAST 来评估疑似中风的患者。由于 ROSIER 包含了所有 FAST 元素，我们从 ROSIER 中计算出 FAST 评分，以便在两种工具之间进行比较。救护车临床医生使用 ROSIER 和计算出的 FAST 做出的临时中风诊断与中风顾问的诊断进行了比较。我们使用逐步逻辑回归比较了个体 ROSIER 和 FAST 项目以及患者人口统计学数据对顾问诊断的预测贡献。
使用 ROSIER 识别的中风患者中有 64%和非中风患者中有 78%被中风顾问随后确认。ROSIER 和 FAST 正确检测中风的比例没有差异，两者都具有出色的敏感性。ROSIER 检测到的非中风病例略多于 FAST，但特异性均较差。面部无力、手臂无力、癫痫发作、年龄和性别预测了顾问对中风的诊断。
ROSIER 对于院前识别中风并不优于 FAST。包含评估癫痫发作的 FAST 修订版可能会提高救护车临床医生对中风的识别和决策能力。
