Dowbiggin Patricia L, Infinger Allison I, Purick Gabrielle, Swanson Douglas R, Studnek Jonathan R
Prehosp Emerg Care. 2021 Jan 12:1-8. doi: 10.1080/10903127.2020.1852350.
Patients experiencing a large vessel occlusion stroke (LVOS) may require endovascular-capable centers and benefit from direct transport to such facilities, creating a need for an accurate prehospital assessment. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) is a secondary scale to identify LVOS. Currently, there is limited prospective evidence validating the use of the FAST-ED in the prehospital environment. This study aimed to evaluate the inter-rater reliability of the FAST-ED between patient care providers in the prehospital setting. This prospective study was conducted between 4/1/2018 and 7/1/2018 in a single municipal EMS agency that staffs two providers per ambulance with at least one being a paramedic. Patients were included based on paramedic impression that the patient was both having a stroke and greater than 18 years old. Each provider independently performed and documented a FAST-ED assessment on eligible patients. Data analysis consisted of performing inter-rater reliability using Cohen's Kappa on the FAST-ED score between primary and secondary providers. The FAST-ED was analyzed on an item level, an aggregate level (cumulative of all items), and using the defined cut point of ≥4. A sub-analysis determined if inter-rater reliability changed across provider certification. There were 231 patients included in this analysis with an average age of 68.5 years and 135 (58.4%) female. Inter-rater reliability varied across individual items in the scale from 90.1% agreement to 82.5%. When analyzing inter-rater reliability of the aggregate FAST-ED score, the scale demonstrated 70.1% agreement (Kappa 0.66), considered substantial agreement. FAST-ED scores were analyzed using a cut point of ≥4. When using this cut point, there was 92.2% (Kappa 0.81) agreement between primary and secondary caregiver, demonstrating almost perfect agreement. Agreement was substantial across provider certifications including paramedics and EMTS. This study demonstrated high inter-rater reliability of the FAST-ED scale when performed in the prehospital setting on patients suspected of having a stroke. There were minimal differences in reliability based on provider certification, and item level analysis indicated substantial inter-rater reliability.
经历大血管闭塞性中风（LVOS）的患者可能需要具备血管内治疗能力的中心，并受益于直接转运至此类机构，因此需要进行准确的院前评估。现场评估中风分诊至急诊目的地（FAST-ED）是一种用于识别LVOS的二级量表。目前，在前院环境中验证FAST-ED使用的前瞻性证据有限。本研究旨在评估院前环境中患者护理提供者之间FAST-ED的评分者间信度。这项前瞻性研究于2018年4月1日至2018年7月1日在一个单一的市政急救机构中进行，该机构每辆救护车配备两名提供者，其中至少一名是护理人员。根据护理人员的判断，患者患有中风且年龄大于18岁，将其纳入研究。每位提供者独立对符合条件的患者进行并记录FAST-ED评估。数据分析包括使用科恩kappa系数对初级和二级提供者之间的FAST-ED评分进行评分者间信度分析。对FAST-ED进行了项目层面、总体层面（所有项目的累积）分析，并使用定义的切点≥4进行分析。一项子分析确定评分者间信度是否因提供者认证而改变。本分析纳入了231例患者，平均年龄68.5岁，女性135例（58.4%）。量表中各个项目的评分者间信度从90.1%的一致性到82.5%不等。在分析FAST-ED总体评分的评分者间信度时，该量表显示一致性为70.1%（kappa系数0.66），被认为是高度一致。使用切点≥4对FAST-ED评分进行分析。使用该切点时，初级和二级护理人员之间的一致性为92.2%（kappa系数0.81），显示几乎完全一致。在包括护理人员和急救医疗技术员在内的提供者认证中，一致性都很高。本研究表明，在院前环境中对疑似中风患者进行FAST-ED量表评估时，评分者间信度很高。基于提供者认证的信度差异最小，项目层面分析表明评分者间信度很高。
