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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Clinical signs in young patients with stroke related to FAST: results of the sifap1 study
Manfred Kaps1, Ulrike Grittner2, Gerhard Jungehülsing3
1Department of Neurology, Justus Liebig University, Giessen, Germany.
Insights
The FAST scheme effectively identifies stroke symptoms in young adults (18-55). This rapid assessment tool is particularly useful for recognizing stroke signs in individuals who may be eligible for thrombolysis.
Area of Science:
- Neurology
- Public Health
Background:
- The Stroke in Young Fabry Patients (sifap1) study is a multinational European prospective cross-sectional initiative.
- This study initially focused on the link between juvenile stroke and Fabry disease.
Purpose of the Study:
- To evaluate the prevalence of stroke warning signs in young adults (18-55 years).
- To assess the utility of the Face, Arm, Speech, Time (FAST) scheme in identifying stroke symptoms in this demographic.
Main Methods:
- Analysis of data from 4535 patients (TIA, ischemic stroke, or other) aged 18-55 years.
- Secondary analysis of the sifap1 study data focusing on presenting stroke symptoms and FAST recognition.
Main Results:
- FAST symptoms were identified in 76.5% of all stroke cases.
- Prevalence of FAST symptoms increased with stroke severity (NIHSS).
- FAST symptom recognition varied by age group, with higher prevalence in older young adults.
Conclusions:
- The FAST scheme is a valuable and rapid tool for identifying stroke symptoms in young adults.
- FAST can identify the majority of stroke patients, especially those considered for thrombolysis.
Objectives:
The present study aimed to evaluate the frequency of warning signs in younger patients with stroke with a special regard to the 'FAST' scheme, a public stroke recognition instrument (face, arm, speech, timely).
Setting:
Primary stroke care in participating centres of a multinational European prospective cross-sectional study (Stroke in Young Fabry Patients; sifap1). Forty-seven centres from 15 European countries participate in sifap1.
Participants:
5023 acute patients with stroke (aged 18-55 years) patients (96.5% Caucasians) were enrolled in the study between April 2007 and January 2010.
Primary And Secondary Outcome Measures:
sifap1 was originally designed to investigate the relation of juvenile stroke and Fabry disease. A secondary aim of sifap1 was to investigate stroke patterns in this specific group of patients. The present investigation is a secondary analysis addressing stroke presenting symptoms with a special regard to signs included in the FAST scheme.
Results:
4535 patients with transient ischaemic attack (TIA; n=1071), ischaemic stroke (n=3396) or other (n=68) were considered in the presented analysis. FAST symptoms could be traced in 76.5% of all cases. 35% of those with at least one FAST symptom had all three symptoms. At least one FAST symptom could be recognised in 69.1% of 18-24 years-old patients, in 74% of those aged 25-34 years, in 75.4% of those aged 35-44 years, and 77.8% in 45-55 years-old patients. With increasing stroke severity signs included in the FAST scheme were more prevalent (National Institute of Health Stroke Scale, NIHSS<5: 69%, NIHSS 6-15: 98.9%, NIHSS>15: 100%). Clustering clinical signs according to FAST lower percentages of strokes in the posterior circulation (65.2%) and in patients with TIA (62.3%) were identified.
Conclusions:
FAST may be applied as a useful and rapid tool to identify stroke symptoms in young individuals aged 18-55 years. Especially in patients eligible for thrombolysis FAST might address the majority of individuals.
Study Registration:
The study was registered in http://www.clinicaltrials.gov (No. NCT00414583).
