From the Michigan State University College of Human Medicine and Spectrum Health, Grand Rapids, (J.A.O.).
Kent County Emergency Medical Services, Grand Rapids, MI (T.C.).
Stroke. 2019 Oct;50(10):2941-2943. doi: 10.1161/STROKEAHA.119.026221. Epub 2019 Aug 6.
Background and Purpose- Emergency medical services (EMS) stroke recognition facilitates rapid care, however, prehospital stroke screening tools rely on signs that are often absent in posterior circulation strokes. We hypothesized that addition of the finger-to-nose (FTN) test to the Cincinnati Prehospital Stroke Scale would improve EMS posterior stroke recognition. Methods- In this controlled before and after study of consecutive EMS transported posterior ischemic strokes, paramedics in a single EMS agency received in-person training in the use of the FTN test. Paramedics at 2 other local EMS agencies served as controls. We compared the change in posterior stroke recognition, door-to-CT times, and alteplase delivery between the FTN (intervention) and control agencies. Results- Over 21 months, 51 posterior circulation strokes were transported by the FTN agency and 88 in the control agencies. Following training, posterior stroke recognition improved from 46% to 74% (=0.039) in the FTN agency, whereas there was no change in the control agencies (32% before versus 39% after, =0.467). Mean door-to-CT time in the FTN agency also improved following training (62-41 minutes, =0.037) but not in the control agencies (58-61 minutes, =0.771). There was no difference in alteplase delivery. Conclusions- Paramedics trained in the FTN test were more likely to identify posterior stroke. If future studies confirm these findings, such training may expedite the care of posterior stroke patients transported by EMS.
背景与目的- 紧急医疗服务（EMS）对脑卒中的识别有助于实现快速救治，然而，院前脑卒中筛查工具依赖的体征往往在后循环脑卒中时缺失。我们假设在辛辛那提院前脑卒中量表中增加指鼻试验（FTN）可提高 EMS 对后循环脑卒中的识别能力。方法- 这是一项连续 EMS 转运的后循环缺血性脑卒中的对照前后研究，单一 EMS 机构的急救员接受了 FTN 试验使用的现场培训。另外 2 家当地 EMS 机构的急救员作为对照组。我们比较了 FTN（干预）和对照组机构的后循环脑卒中识别率、门到 CT 时间和阿替普酶给药的变化。结果- 在 21 个月期间，51 例后循环脑卒中由 FTN 机构转运，88 例由对照组机构转运。在培训后，FTN 机构的后循环脑卒中识别率从 46%提高到 74%（=0.039），而对照组机构则没有变化（培训前为 32%，培训后为 39%，=0.467）。FTN 机构的门到 CT 时间也在培训后得到改善（从 62 分钟到 41 分钟，=0.037），而对照组机构则没有变化（从 58 分钟到 61 分钟，=0.771）。阿替普酶给药没有差异。结论- 接受 FTN 试验培训的急救员更有可能识别出后循环脑卒中。如果未来的研究证实了这些发现，这种培训可能会加快 EMS 转运的后循环脑卒中患者的救治。
