Pickham David, Valdez André, Demeestere Jelle, Lemmens Robin, Diaz Linda, Hopper Sherril, de la Cuesta Karen, Rackover Fannie, Miller Kenneth, Lansberg Maarten G
Prehosp Emerg Care. 2019 Mar-Apr;23(2):195-200. doi: 10.1080/10903127.2018.1490837. Epub 2018 Aug 23.
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 whether adding coordination (Balance) and diplopia (Eyes) assessments increase the accuracy of the Face-Arms-Speech-Time (FAST) scale in a multisite prospective study of emergency response activations for presumed stroke.
This was a prospective study of emergency response activations for presumed stroke in Santa Clara County, California. Emergency medical responders were trained in the Balance-Eyes-Face-Arms-Speech-Time (BEFAST) scale and administered the scale on scene to all patients who were within 6 hours of onset of neurological symptoms. Each 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.
Three hundred fifty-nine patients were included in our analysis. Compared to nonstroke 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 (area under the curve [AUC] = 0.70 vs. AUC = 0.69, p = 0.36). Optimal cutoff for stroke detection was ≥1 for both scales. At this threshold, the positive predictive value (PPV) was 0.49 for the BEFAST and 0.53 for the FAST scale, and the negative predictive value (NPV) was 0.93 for BEFAST and 0.86 for FAST.
Adding coordination and diplopia assessments to face, arm, and speech assessment does not improve stroke detection in the prehospital setting.
使用院前卒中量表可能会提高卒中检测率，并改善治疗率和缩短延误时间。然而，目前的量表可能缺乏检测准确性。因此，在一项关于疑似卒中的应急反应启动的多中心前瞻性研究中，我们研究了增加协调（平衡）和复视（眼睛）评估是否能提高面-臂-言语-时间（FAST）量表的准确性。
这是一项针对加利福尼亚州圣克拉拉县疑似卒中的应急反应启动的前瞻性研究。急救人员接受了平衡-眼睛-面-臂-言语-时间（BEFAST）量表的培训，并在现场对所有出现神经症状6小时内的患者使用该量表进行评估。每位患者的最终诊断（卒中与非卒中）基于医院记录的审查。我们比较了BEFAST量表和FAST量表在卒中检测方面的表现。
359名患者纳入我们的分析。与非卒中患者（n = 200）相比，卒中患者（n = 159）在BEFAST量表的五个要素中每项的得分更常为阳性（每项p < 0.05）。在多变量分析中，只有面部下垂和手臂无力是卒中的独立预测因素（p < 0.05）。BEFAST量表和FAST量表在卒中识别方面的准确性相当（曲线下面积[AUC] = 0.70对AUC = 0.69，p = 0.36）。两种量表用于卒中检测的最佳截断值均为≥1。在此阈值下，BEFAST量表的阳性预测值（PPV）为0.49，FAST量表为0.53，BEFAST量表的阴性预测值（NPV）为0.93，FAST量表为0.86。
在对面部、手臂和言语评估中增加协调和复视评估并不能改善院前环境中的卒中检测。
