Introduction: In March 2017 Miami-Dade Fire Rescue (MDFR) started to use the FAST-ED score (FES) as the tool to triage those with possible large vessel occlusions (LVO). All suspected of having a stroke should have the score calculated. Those with a score ≥ 4 bypass for a comprehensive stroke center (CSC). Those with a score ≥ 6 have the interventional team activated from the field. We sought to describe basic compliance and performance measures of this initiative.
Methods: All acute stroke patients brought to our CSC by MDFR during the months of March, April, and May were included. Patients were identified based on stroke ICD-10 codes. Study variables are obtained prospectively as part of our internal quality monitoring protocol. FES was obtained from 3 sources: run sheet, medical record, and retrospectively calculated from the first hospital NIHSS performed by trained stroke nurses. An LVO is present if there is an occlusion of the internal carotid artery, middle cerebral artery (M1 or M2 segments), or basilar artery on initial imaging.
Results: We identified 320 stroke alerts, 164 from EMS of which 139 were from MDFR and subject to our analysis. The average age was 72 years, 52% female, average NIHSS of 10.3. A total of 79% had an FES described in the run sheet. The field score varied by ≥ 2 points on 51% of patients when compared to the calculated score. Of all stroke alerts 60% were ultimately coded as stroke or TIA. If restricted to run sheet FES ≥ 4 or ≥ 6, the number of patients coded as stroke or TIA were 69% and 58%, respectively. The number of patients found to have a large vessel occlusion was 13 (29%) for FS ≥4 and 6 (32%) for ≥6. The number of patients undergoing endovascular treatment was 10 (22%) for a FS ≥4 and 5 (26%) for FS ≥6.
Discussion: Protocol compliance was good. We found significant differences in the run sheet FES compared to the calculated score. Because these scores are calculated at two different time points the finding could be explained by changes in the patient’s symptoms or to inter-rater variability. In a real life scenario, 2 out of 5 patients with a FS ≥ 6 have an ischemic stroke mimic and only 1 out of 4 will undergo a thrombectomy. Further improvements are required to minimize unnecessary hospital bypass and interventionist field activations.