Implementation and Validation of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) in a Rural EMS...

Area of Science:

• Neurology
• Emergency Medicine
• Public Health

Background:

• Prehospital identification of large vessel occlusion (LVO) stroke is critical for initiating timely mechanical thrombectomy (MT).
• The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score is a validated tool for predicting LVO.
• The utility of FAST-ED in rural, multi-state emergency medical services (EMS) systems requires investigation.

Purpose of the Study:

• To evaluate the accuracy of the FAST-ED score in identifying LVO stroke patients in a rural, multi-state EMS setting.
• To assess the FAST-ED score's ability to predict appropriate destination to a Thrombectomy Capable Center (TCC).
• To determine the association of FAST-ED scores with MT rates and 30-day mortality.

Main Methods:

• Prospective cohort study of prehospital stroke alerts in Vermont, New Hampshire, and Maine (July 2021-December 2022).
• Inclusion of patients with recorded prehospital FAST-ED scores; LVO confirmed by CT angiography.
• Primary outcome: FAST-ED accuracy for LVO identification; secondary outcomes: TCC appropriateness, MT, and 30-day mortality prediction.

Main Results:

• Study included 370 patients; LVO prevalence was 23.2%.
• FAST-ED demonstrated 73% sensitivity and 61% specificity for LVO detection.
• Positive FAST-ED scores significantly correlated with higher TCC appropriateness (46% vs 10%), MT rates (19% vs 6%), and 30-day mortality (24% vs 6%).

Conclusions:

• The FAST-ED score is implementable by prehospital personnel for triaging stroke patients to TCCs in rural settings.
• Incorporating FAST-ED scoring into rural EMS protocols can facilitate appropriate diversion to TCCs.
• Further research is needed to explore the impact of prehospital diversion on thrombectomy times, functional outcomes, and mortality.