Identification of stroke during the emergency call: a descriptive study of callers' presentation of stroke.
OBJECTIVE
To evaluate symptoms presented by the caller during emergency calls regarding stroke, and to assess if symptoms in the Face-Arm-Speech-Time Test (FAST) are related to identification of stroke.


METHODS
Emergency calls to the Emergency Medical Communication Center (EMCC) concerning patients discharged with stroke diagnosis in a large teaching hospital in Stockholm, Sweden, in January-June 2011.


METHODS
The emergency calls of 179 patients who arrived at hospital by ambulance, and who were discharged with a stroke diagnosis and consented to participate were included in the study.


METHODS
Frequencies of stroke symptoms presented and a comparison of symptoms presented in calls with dispatch code stroke or other dispatch code.


RESULTS
Of the 179 emergency calls analysed, 64% were dispatched as 'Stroke'. FAST symptoms, that is, facial or arm weakness or speech disturbances, were presented in 64% of the calls and were spontaneously revealed in 90%. Speech disturbance was the most common problem (54%) in all calls, followed by fall/lying position (38%) and altered mental status (27%). For patients with dispatch codes other than stroke, the dominating problem presented was a fall or being in a lying position (66%), followed by speech disturbance (31%) and altered mental status (25%). Stroke-specific symptoms were more common in patients dispatched as stroke. FAST symptoms were reported in 80% of patients dispatched as stroke compared with 35% in those dispatched as something else.


CONCLUSIONS
This study implicates that fall/lying position and altered mental status could be considered as possible symptoms of stroke during an emergency call. Checking for FAST symptoms in these patients might uncover stroke symptoms. Future studies are needed to evaluate if actively asking for FAST symptoms in emergency calls presenting falls or a lying position can improve the identification of stroke.


BACKGROUND
Stroke2010/703-31/2.
Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden Section of Neurology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden.
Annika
A
Berglund
Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden Section of Neurology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden.
Mia
M
von Euler
Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Karin
K
Schenck-Gustafsson
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Maaret
M
Castrén
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
Katarina
K
Bohm
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D042241:Early Diagnosis; D004631:Emergency Medical Service Communication Systems; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis*; D013548:Sweden; D014218:Triage / Q000379:methods*
ACCIDENT & EMERGENCY MEDICINE; STROKE MEDICINE