Agreement Between Ambulance Paramedic- and Physician-Recorded Neurological Signs With Face Arm Speech Test (FAST) in Acute Stroke Patients

• DOI: 10.1161/01.str.0000128529.63156.c5
• Publication Date: 2004-05-04T00:49:25Z
• Authors: A. Mohd Nor; C. McAllister; S.J. Louw; A.G. Dyker; M. Davis; D. Jenkinson; G.A. Ford
• Keywords: Stroke; Facial weakness; Acute stroke; Triage

Patients with suspected stroke first assessed by ambulance paramedics require early recognition to facilitate appropriate triage and treatment. We determined paramedic's accuracy in detecting acute signs comparing agreement between neurological recorded the Face Arm Speech Test (FAST), a instrument, on scene physicians after admission.Suspected patients admitted directly an unit through rapid protocol were examined trainee neurologist or admitting physician over 1-year period. Recorded (facial weakness, arm speech disturbance) confirmed stroke/transient ischemic attack (TIA) cases compared neurologist/physician.Ambulance crews referred 278 of whom 217 (78%) had (n=189) TIA (n=28); 95% (median 18 hours paramedic assessment). group were: facial 68% versus 70% (kappa=0.49; CI: 0.36 0.62); 96% (kappa=0.77; 0.55 0.99); disturbance, 79% 77% (kappa=0.69; 0.56 0.82). Interrater was complete for weakness 98% cases.Recognition deficits using FAST shows good assessment, even allowing temporal evolution deficits. The high prevalence suggest that this sign may have greatest usefulness prehospital paramedic-based neuroprotective trials.