Prehospital FAST-ED Score Item Agreement with Corresponding In-Hospital NIHSS Item Scores

Area of Science:

• Neurology
• Emergency Medicine
• Public Health

Background:

• Emergency medical services (EMS) expedite treatment for acute ischemic stroke (AIS) by directly transporting large vessel occlusion (LVO) patients to thrombectomy centers.
• The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) is a prehospital tool used by EMS to identify LVO AIS.
• This study evaluates the agreement between field FAST-ED assessments and in-hospital National Institutes of Health Stroke Scale (NIHSS) scores.

Purpose of the Study:

• To assess the agreement of individual FAST-ED score items performed by paramedics with corresponding NIHSS items recorded by neurologists.
• To identify specific areas where prehospital stroke assessment may require refinement.

Main Methods:

• Retrospective analysis of a prospectively maintained "Code Stroke" patient registry.
• Inclusion of patients aged 18+ with documented FAST-ED scores and AIS diagnosis.
• Utilized Fleiss Kappa statistics to measure agreement between paramedic and neurologist assessments for various stroke symptoms.

Main Results:

• Substantial agreement was found for arm weakness (Kappa=0.68) and certain speech changes (Kappa=0.61).
• Moderate agreement was observed for eye deviation (Kappa=0.60) and other speech changes (Kappa=0.48).
• Fair agreement was noted for facial palsy (Kappa=0.25) and denial/neglect (Kappa=0.33).

Conclusions:

• Agreement between prehospital FAST-ED and in-hospital NIHSS varied across different stroke indicators.
• Targeted education for EMS clinicians on assessing facial palsy and denial/neglect is recommended.
• Refined training on scoring speech deficits, particularly isolated dysarthria, could improve prehospital stroke assessment accuracy.