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The FAST-ED App: A Smartphone Platform for the Field Triage of Patients With Stroke
Raul G Nogueira1, Gisele S Silva2, Fabricio O Lima2
1Marcus Stroke and Neuroscience Center (R.G.N., C.F., J.J.R., M.B., J.A.G., D.C.H., M.R.F.) and Department of Emergency Medicine (A.H.Y., J.J.R.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Neurology, Federal University of São Paulo/UNIFESP and Programa Integrado de Neurologia, Hospital Israelita Albert Einstein, Brazil (G.S.S.); Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Brazil (F.O.L.); Allm Group, Tokyo, Japan (Y.-C.Y., T.S.); Medicinia, Sao Paulo, Brazil (D.B.); and Georgia Office of EMS and Trauma, Brookhaven (R.K.W., E.D.). raul.g.nogueira@emory.edu.
Background And Purpose:
The Emergency Medical Services field triage to stroke centers has gained considerable complexity with the recent demonstration of clinical benefit of endovascular treatment for acute ischemic stroke. We sought to describe a new smartphone freeware application designed to assist Emergency Medical Services professionals with the field assessment and destination triage of patients with acute ischemic stroke.
Methods:
Review of the application's platform and its development as well as the different variables, assessments, algorithms, and assumptions involved.
Results:
The FAST-ED (Field Assessment Stroke Triage for Emergency Destination) application is based on a built-in automated decision-making algorithm that relies on (1) a brief series of questions assessing patient's age, anticoagulant usage, time last known normal, motor weakness, gaze deviation, aphasia, and hemineglect; (2) a database of all regional stroke centers according to their capability to provide endovascular treatment; and (3) Global Positioning System technology with real-time traffic information to compute the patient's eligibility for intravenous tissue-type plasminogen activator or endovascular treatment as well as the distances/transportation times to the different neighboring stroke centers in order to assist Emergency Medical Services professionals with the decision about the most suitable destination for any given patient with acute ischemic stroke.
Conclusions:
The FAST-ED smartphone application has great potential to improve the triage of patients with acute ischemic stroke, as it seems capable to optimize resources, reduce hospital arrivals times, and maximize the use of both intravenous tissue-type plasminogen activator and endovascular treatment ultimately leading to better clinical outcomes. Future field studies are needed to properly evaluate the impact of this tool in stroke outcomes and resource utilization.
