Background: Emergency medical services (EMS) stroke recognition is critical for appropriate triage and rapid activation of stroke systems. Posterior strokes represent up to 25% of acute stroke admissions. Prehospital stroke screening tools such as the Cincinnati Prehospital Stroke Scale (CPSS) rely on stroke signs that may not be present in patients with posterior stroke, resulting in delays in diagnosis and treatment. We hypothesized that addition of the finger to nose test (FNT) to the standard CPSS would improve EMS recognition of posterior stroke.
Methods: Over a 21-month period consecutive ischemic stroke cases transported by 3 EMS agencies in a single county in southwestern Michigan were identified and classified as anterior, posterior, or indeterminate based upon the final hospital discharge diagnoses. Following a 12-month baseline data collection period, all paramedics in the county completed a 30-minute on-line training module targeting recognition of stroke symptoms. Additionally, paramedics in 1 of the 3 EMS agencies also received in-person training in the performance of the finger to nose test (FNT group). We calculated the change in EMS posterior stroke recognition between the 12-month preintervention period and the 9-month postintervention period in the agency that received FNT training, and compared this to the change in the 2 control agencies that did not received FNT education intervention.
Results: Over 21 months, 798 ischemic stroke cases were transported by EMS; 114 (14%) were posterior circulation strokes. Before training, 9/26 (38%) of posterior strokes were recognized by paramedics in the intervention agency and 10/36 (28%) in the 2 control agencies. Following training, the FTN group recognized 12/16 (75%, p=0.02 compared to 38% baseline) posterior strokes while the control group recognized 13/23 (46%, p=0.2 compared to 28% baseline). The net increase in posterior stroke recognition was therefore greater in the CPSS-A group than in the control agencies (37% vs. 18%, p=0.03).
Conclusion: Posterior strokes were more likely to be recognized by paramedics when the finger to nose test was added to the CPSS. These encouraging initial results demonstrate the potential value of incorporating this simple test into EMS training.