Pre-hospital stroke screening and notification of patients with reperfusion-eligible acute ischaemic stroke using modified face arm speech time test

Abstract

Objectives: To investigate the effects of pre-hospital stroke screening and notification on reperfusion therapy for patients with acute ischaemic stroke.

Methods: Pre-hospital stroke screening criteria were established based on a modified version of the Face Arm Speech Time (FAST) test. Screening was performed during ambulance transport by emergency medical service (EMS) personnel who completed a 2-hour training session on stroke screening. Temporal trends affecting acute ischaemic stroke investigation and intervention were compared before and after implementation of the pre-hospital screening.

Results: From July 2018 to October 2019, 298 patients with suspected stroke were screened by EMS personnel during ambulance transport prior to hospital arrival. Of these 298 patients, 213 fulfilled the screening criteria, 166 were diagnosed with acute stroke, and 32 received reperfusion therapy. The onset-to-door time was shortened by more than 1.5 hours (100.6 min vs 197.6 min, P<0.001). The door-to–computed tomography time (25.6 min vs 32.0 min, P=0.021), door-to-needle time (49.2 min vs 70.1 min, P=0.003), and door-to–groin puncture time for intra-arterial mechanical thrombectomy (126.7 min vs 168.6 min, P=0.04) were significantly shortened after implementation of the pre-hospital screening and notification, compared with historical control data of patients admitted from January 2018 to June 2018, before implementation of the screening system.

Conclusion: Implementation of pre-hospital stroke screening using criteria based on a modified version of the FAST test, together with pre-arrival notification, significantly shortened the door-to-reperfusion therapy time for patients with ischaemic stroke. Pre-hospital stroke screening during ambulance transport by EMS personnel who complete a 2-hour focused training session is effective for identifying reperfusion-eligible patients with stroke.

目的：探討急性缺血性中風患者院前中風篩查和通報再灌注治療的影響。 方法：基於中風「快速」測試（FAST）修改版建立院前中風篩查標準。已完成2小時中風篩查培訓的緊急醫療服務人員在救護車運輸過程中為患者進行院前篩查。將院前中風篩查實施前和實施後對影響急性缺血性中風檢查和干預的時間趨勢作出比較。 結果：2018年7月至2019年10月，緊急醫療服務人員在救護車運輸過程中對298名疑似中風患者進行院前篩查。這298例患者中，213例符合篩查標準，其中166例被診斷為急性中風，其中32例接受再灌注治療。與2018年1月至2018年6月入院患者的歷史對照數據，即實施院前中風篩查前相比，實施院前中風篩查後發病至入院需時減少超過1.5小時（100.6分鐘比197.6分鐘，P< 0.001）。入院至電腦掃描（25.6分鐘比32.0分鐘，P=0.021）、入院至上針（49.2分鐘比70.1分鐘，P=0.003），以及入院至股動脈穿刺進行機械取栓術（126.7分鐘比168.6分鐘，P=0.04）需時也明顯縮短。 結論：使用基於中風「快速」測試（FAST）修改版建立院前中風篩查標準並結合入院前通報，可顯著縮短缺血性中風患者的入院至再灌注治療時間。由完成2小時中風篩查培訓的緊急醫療服務人員在救護車運輸過程中為患者進行院前篩查，能有效識別符合再灌注治療條件的中風患者。