title: Field Assessment Stroke Triage for Emergency Destination: A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes.
abstract: Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS.
  
  
  
  The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale was based on items of the National Institutes of Health Stroke Scale (NIHSS) with higher predictive value for LVOS and tested in the Screening Technology and Outcomes Project in Stroke (STOPStroke) cohort, in which patients underwent computed tomographic angiography within the first 24 hours of stroke onset. LVOS were defined by total occlusions involving the intracranial internal carotid artery, middle cerebral artery-M1, middle cerebral artery-2, or basilar arteries. Patients with partial, bihemispheric, and anterior+posterior circulation occlusions were excluded. Receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value of FAST-ED were compared with the NIHSS, Rapid Arterial Occlusion Evaluation (RACE) scale, and Cincinnati Prehospital Stroke Severity (CPSS) scale.
  
  
  
  LVO was detected in 240 of the 727 qualifying patients (33%). FAST-ED had comparable accuracy to predict LVO to the NIHSS and higher accuracy than RACE and CPSS (area under the receiver operating characteristic curve: FAST-ED=0.81 as reference; NIHSS=0.80, P=0.28; RACE=0.77, P=0.02; and CPSS=0.75, P=0.002). A FAST-ED ≥4 had sensitivity of 0.60, specificity of 0.89, positive predictive value of 0.72, and negative predictive value of 0.82 versus RACE ≥5 of 0.55, 0.87, 0.68, and 0.79, and CPSS ≥2 of 0.56, 0.85, 0.65, and 0.78, respectively.
  
  
  
  FAST-ED is a simple scale that if successfully validated in the field, it may be used by medical emergency professionals to identify LVOS in the prehospital setting enabling rapid triage of patients.
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
authors.forename: Fabricio O
authors.initials: FO
authors.lastname: Lima
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
authors.forename: Gisele S
authors.initials: GS
authors.lastname: Silva
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
authors.forename: Michael R
authors.initials: MR
authors.lastname: Frankel
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
authors.forename: Michael H
authors.initials: MH
authors.lastname: Lev
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
authors.forename: Érica C S
authors.initials: ÉC
authors.lastname: Camargo
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
authors.forename: Diogo C
authors.initials: DC
authors.lastname: Haussen
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
authors.forename: Aneesh B
authors.initials: AB
authors.lastname: Singhal
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Koroshetz
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
authors.forename: Wade S
authors.initials: WS
authors.lastname: Smith
authors.affiliation: From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.). raul.g.nogueira@emory.edu.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000072226:Computed Tomography Angiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014218:Triage / Q000379:methods*
keywords: cerebrovascular occlusion; scale; stroke, acute, prehospital emergency care; triage