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Reliability of Field Assessment Stroke Triage for Emergency Destination Scale Use by Paramedics: Mobile Stroke Unit
Nirav R Bhatt1,2, Michael R Frankel1,2, Raul G Nogueira1,2
1Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (N.R.B., M.R.F., R.G.N., N.A.B., S.W.E., N.J., D.N., D.C.H.).
Paramedics accurately use the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale in mobile stroke units. This tool shows excellent reliability for prehospital stroke assessment, improving emergency destination decisions.
Area of Science:
- Neurology
- Emergency Medicine
- Prehospital Care
Background:
- The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale aids prehospital stroke triage.
- Reliability data for FAST-ED in prehospital settings are limited.
Purpose of the Study:
- To assess the reliability of the FAST-ED scale when used by paramedics in a mobile stroke unit.
- To evaluate interrater agreement between paramedics and vascular neurologists (VN) for FAST-ED scoring.
Main Methods:
- Paramedics and VNs independently scored FAST-ED for stroke alert patients.
- Interrater agreement was analyzed using intraclass correlation coefficient (ICC).
- Data collected from 173 patients over 15 months in a metropolitan area.
Main Results:
- FAST-ED scores matched perfectly in 56% of cases and had a 0-2 point difference in 98.8%.
- Excellent reliability was demonstrated with an ICC of 0.94 (95% CI, 0.92–0.96).
- Paramedics correctly identified FAST-ED scores ≥3 in 87.5% of cases where VNs did.
Conclusions:
- The FAST-ED scale is reliably performed by paramedics in the prehospital setting.
- This supports the accurate use of FAST-ED by paramedics for stroke triage.
- Mobile stroke units can effectively utilize paramedics for FAST-ED assessments.
