Effect of FAST-ED Implementation and Age on Distance Patients Travel from Scene to Comprehensive Stroke Center

The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) is a pre-hospital screening tool used to detect large vessel occlusion (LVO) strokes. FAST-ED was implemented by Miami-Dade Fire Rescue (MDFR) in March 2017 with a goal to bring potential LVO patients directly to a Comprehensive Stroke Center (CSC). We assessed whether use of the FAST-ED increased distance patients traveled, assuming some patients would bypass other centers to come to a CSC. This is a retrospective study examining distance traveled by MDFR for acute stroke alerts. Data from three periods were compared: (A) Mar-May 2017 after implementation of FAST-ED, (B) Mar-May 2016, the year before implementation, and (C) Dec 2016-Feb 2017, just before implementation. Distance traveled in miles from scene to our CSC was obtained from MDFR incident reports. Data also were analyzed by age (≥80 years). In total, 429 acute stroke alerts brought by MDFR to our CSC were reviewed. There were 138 cases in Period A, 136 in Period B, and 155 in Period C. Out of those cases, 156 were aged ≥80 years; 49/138 (36%) in Period A, 45/136 (33%) in Period B, and 62/155 (40%) in Period C. A two-factor ANOVA was used to examine the effect of FAST-ED implementation and age on distance traveled. Patients ≥80 years traveled statistically significantly shorter distances (7.0 mi) than those \u3c80 \u3e(9.0 mi), regardless of period [F(1,5)=13.70,

Effects of Ethnicity and Prior Depression on Hospital Course and Outcomes in First-Time Stroke Patients

Stroke is the fifth leading cause of death in the US and can result in major disability. Depression can increase risk of stroke and death from stroke, and it is related to worse post-stroke outcomes. There is a dearth of research in Hispanic people, who have a higher burden of disease than non-Hispanic people. The goal of this project was to determine how ethnicity and prior depression affect patient outcomes after first-time stroke. Five hundred cases from Baptist Hospital\u27s Get With The Guidelines-Stroke database (9/14-5/15) were analyzed. It was a 2 (Hispanic, non-Hispanic) x 2 (prior depression, no prior depression) factorial cross-sectional design. Descriptive statistics analyzed subjects on baseline characteristics (demographics, comorbidities, and NIH Stroke Scale score), hospital course [IV t-PA or neuro-intervention and their turnaround times, and length of stay (LOS)], discharge functional status [modified Rankin Scale (mRS)], and discharge disposition. Nonparametric median test was used for LOS and χ2 analysis was used for mRS and disposition. Of 500 cases, 199 were excluded because of: prior stroke, TIA, MI, or atrial fibrillation, or LOS≥30 days. Of 301 cases, 195 patients were Hispanic (65%), and 30 had depression (21/195 Hispanic, 12%; 9/97 non-Hispanic, 9%). A marginally significant interaction of ethnicity and depression was found (p=0.061), such that non-Hispanic patients with depression had a shorter LOS than the other groups (3.7 d vs. 6.3-6.9 d). Of 301 patients, 171 (57%) were discharged home. Hispanic patients were less likely to be discharged home (54%) vs. 62% of non-Hispanic patients, regardless of depression. Of 279 patients with a mRS score, 98 (35%) had a good clinical outcome. Only 1/4 of Hispanic patients with depression had a good clinical outcome, vs. 1/3 of patients in the other groups. There was an interaction of ethnicity and depression on LOS where non-Hispanic patients with depression had a shorter LOS than other groups. These findings may be clinically important. It is critical to determine whether these patients had less severe strokes or fewer comorbidities, or if patients were discharged too quickly

A Real World Experience of the FAST-ED Based Pre-Hospital Stroke Triage System to Detect Large Vessel Occlusions

Introduction: In March 2017, the Fire Officers Association of Miami-Dade employed the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale to better identify large vessel occlusion (LVO) strokes. Individuals with a score≥4 bypass other centers for a comprehensive stroke center, whereas those with a score ≥6 also have the interventional team activated from the field. The FAST-ED scale was developed using a retrospective cohort of ischemic strokes and TIAs. There have been no prospective, real world examples on the performance of this tool when used in the field by emergency personnel. Methods: Stroke alert cases brought to our center byFOAMD during March 2017-August 2018 were analyzed. We used the FAST-ED score documented on the EMS run sheet and examined the incidence of LVOs and treatment rates for applicable cases. Cases without FAST-ED scores were excluded. Results: A total of 686 patients met criteria. Of these, 354 (52%) had ischemic stroke, and 135 (20%) had a LVO. Of all LVOs, 39% had score of ≥6, whereas 72% had a score of ≥4. Out of all stroke alerts with a FAST-ED score ≥4, 97 (31%) had a LVO and 72 (23%) were treated with mechanical reperfusion (MR). Of all stroke alerts with a score ≥6, 53 (38%) had a LVO and 43 (31%) were treated endovascularly. The endovascular team was activated from the field on 92 cases with a score ≥6 during off hours, but only 30 (33%) had MR. Discussion: In a real world experience of the FAST-ED score being completed in the field, the detection of LVOs was much lower than in the initial report. Almost 1/3 of cases with a score of ≥4 and more than 1/3 with ≥6 had a LVO, and most of those cases were treated endovascularly. Only 1/3 of field activations led to an endovascular procedure