Ambulance Clinical Triage for Acute Stroke Treatment

Autor: Patrick Salvaris, Nawaf Yassi, Edrich Rodrigues, Stephen Bernard, Bruce C.V. Campbell, Lauren Pesavento, Michael Stephenson, Leonid Churilov, Stephen M. Davis, Henry Zhao, Karen Smith, Skye Coote
Rok vydání: 2018
Předmět:
Adult
Male
Emergency Medical Services
Ambulances
030204 cardiovascular system & hematology
Sensitivity and Specificity
Time-to-Treatment
Young Adult
03 medical and health sciences
0302 clinical medicine
Emergency medical services
Humans
Medicine
Ambulance Diversion
Prospective Studies
Prospective cohort study
Stroke
Aged
Retrospective Studies
Thrombectomy
Aged
80 and over
Advanced and Specialized Nursing
business.industry
Endovascular Procedures
Reproducibility of Results
Infarction
Middle Cerebral Artery
Retrospective cohort study
Cerebral Infarction
Middle Aged
medicine.disease
Triage
Confidence interval
Cerebrovascular Disorders
Emergency Medical Technicians
Female
Neurology (clinical)
Emergency Service
Hospital
Cardiology and Cardiovascular Medicine
business
Algorithm
Algorithms
Carotid Artery
Internal
030217 neurology & neurosurgery
Large vessel occlusion
Zdroj: Stroke. 49:945-951
ISSN: 1524-4628
0039-2499
Popis: Background and Purpose— Clinical triage scales for prehospital recognition of large vessel occlusion (LVO) are limited by low specificity when applied by paramedics. We created the 3-step ambulance clinical triage for acute stroke treatment (ACT-FAST) as the first algorithmic LVO identification tool, designed to improve specificity by recognizing only severe clinical syndromes and optimizing paramedic usability and reliability. Methods— The ACT-FAST algorithm consists of (1) unilateral arm drift to stretcher Results— In retrospective (n=565) and prospective paramedic (n=104) validation, ACT-FAST displayed higher overall accuracy and specificity, when compared with existing LVO triage scales. Agreement of ACT-FAST between paramedics and doctors was excellent (κ=0.91; 95% confidence interval, 0.79–1.0). The full ACT-FAST algorithm (n=60) assessed by paramedics showed high overall accuracy (91.7%), sensitivity (85.7%), specificity (93.5%), and positive predictive value (80%) for recognition of endovascular-eligible LVO. Conclusions— The 3-step ACT-FAST algorithm shows higher specificity and reliability than existing scales for clinical LVO recognition, despite requiring just 2 examination steps. The inclusion of an eligibility step allowed recognition of endovascular-eligible patients with high accuracy. Using a sequential algorithmic approach eliminates scoring confusion and reduces assessment time. Future studies will test whether field application of ACT-FAST by paramedics to bypass suspected patients with LVO directly to endovascular-capable centers can reduce delays to endovascular thrombectomy.
Databáze: OpenAIRE
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