De Los Rios La Rosa, Felipe

Gonzalez, Ivis

Ramirez, Maygret

Ramos, Virginia

Starosciak, Amy

Strauss, Jayme

English

Scholarly Commons@Baptist Health South Florida

Baptist Health South FloridaScholarly Commons @ Baptist Health South FloridaAll Publications12-2017Symptom Screening Improves Accuracy of theFAST-ED ScaleAmy StarosciakBaptist Health South Florida, amyst@baptisthealth.netMaygret RamirezBaptist Hospital of Miami, maygretr@baptisthealth.netJayme StraussBaptist Hospital of Miami; Baptist Neuroscience Center, jaymes@baptisthealth.netVirginia RamosBaptist Hospital of Miami, VirginiR@baptisthealth.netIvis GonzalezBaptist Hospital of Miami, IvisGo@baptisthealth.netSee next page for additional authorsFollow this and additional works at: https://scholarlycommons.baptisthealth.net/se-all-publicationsThis Conference Poster -- Open Access is brought to you for free and open access by Scholarly Commons @ Baptist Health South Florida. It has beenaccepted for inclusion in All Publications by an authorized administrator of Scholarly Commons @ Baptist Health South Florida. For moreinformation, please contact Carrief@baptisthealth.net.CitationStarosciak, Amy; Ramirez, Maygret; Strauss, Jayme; Ramos, Virginia; Gonzalez, Ivis; and De Los Rios La Rosa, Felipe, "SymptomScreening Improves Accuracy of the FAST-ED Scale" (2017). All Publications. 2874.https://scholarlycommons.baptisthealth.net/se-all-publications/2874AuthorsAmy Starosciak, Maygret Ramirez, Jayme Strauss, Virginia Ramos, Ivis Gonzalez, and Felipe De Los Rios LaRosaThis conference poster -- open access is available at Scholarly Commons @ Baptist Health South Florida:https://scholarlycommons.baptisthealth.net/se-all-publications/2874Elevating care through discoverySymptom Screening Improves Accuracy of the FAST-ED ScaleBruno Panzarini, Joseph Souchak, Jake Levine, Amy K. Starosciak, Ph.D., Maygret Ramirez, ARNP, Jayme Strauss, MSN, RN, MBA, Virginia Ramos, RN, Ivis C. Gonzalez, RN, Camila Tocre Carrion, Felipe De Los Rios La Rosa, M.D.INTRODUCTIONThe Field Assessment Stroke Triage for Emergency Destination(FAST-ED) scale was developed to detect large vessel occlusionstrokes and to address the time-sensitive nature of endovascularinterventions. Miami-Dade Fire Rescue implemented this scale inMarch 2017 to bypass directly to a Comprehensive Stroke Centerwhen a FAST-ED scores ≥ 4 and to field activate the endovascularteam for scores ≥ 6.PURPOSEWe sought to determine whether a stroke alert with FAST-ED ≥ 4could be more accurately assessed as ischemic stroke (CVA) if caseswith symptoms of increased intracranial pressure (ICP) wereexcluded. With a more accurate field diagnosis, physicians canmake quicker and better decisions on the most appropriatetreatment and care.METHODSData were analyzed from patients with FAST-ED ≥ 4 who werebrought to Baptist Hospital via EMS from March-September 2017.Cases were stratified by discharge diagnosis: CVA, intracerebralhemorrhage (ICH), subarachnoid hemorrhage (SAH), transientischemic attack (TIA), and stroke mimics (SM). Prevalence ofsymptoms of increased ICP, such as headache, nausea, vomiting,and degrees of altered mental status was examined in each stroketype. Proportions of stroke types were compared before and afterexclusion of cases with these symptoms to determine which factorscould lead to a more accurate field diagnosis of CVA.Figure 1. There were 350 stroke alertsfrom EMS, 275 had a FAST-EDdocumented, and 130 had FAST-ED ≥4. Percent of stroke types out of 130EMS stroke alerts with FAST-ED ≥ 4.Figure 2. Frequency of symptoms of increased ICP across stroke types.Figure 3. Frequency of levels of mental status across stroke types.RESULTS (cont’d)• 2 cases of SAH were excluded from analysis because oflow volume and 5 cases were excluded becauseaccurate mental status was not documented• When cases with symptoms of increased ICP wereexcluded, relative proportions of CVA vs. ICH were notstatistically significantly different from the originalproportions (χ2 = 0.069, p>0.05).• Relative risk (RR) was calculated as the probability ofidentifying a CVA when cases with specific symptomswere excluded vs. the probability of identifying a CVAwithout exclusion. RR ≈ 1 signifies no difference in risk.Table 1.  RR for identifying CVA when cases with these symptoms were excluded vs. no exclusions. • RR decreased when patients with A&O were excluded (RR=0.88, CI95 0.69-1.12), p>0.05).  CONCLUSIONSSymptom exclusion did not improve the ability of FAST-EDto detect CVA. In fact, cases where patients are A&O arelikely to have a CVA, therefore A&O should not be used asan exclusion to improve FAST-ED. In fact, one should notunderestimate the severity of a potential stroke in A&Opatients, because they could still be candidates forendovascular therapy. We hypothesized that makingchanges to the FAST-ED based symptoms of increased ICPmade sense in theory, but it did not work retrospectively.We recommend the FAST-ED protocol remain as-is unlessnew evidence emerges.RESULTSCVA62%SM 22%ICH11%TIA 3%SAH2%024681012CVA TIA ICH SM731311221Vomiting  (V) Nausea (N) Moderate HA (MHA) Severe HA (SHA)01530456075CVA TIA ICH SM403 311163 47132864Alert and oriented (A&O) Alert but confused (A&C)Drowsy or somnolent (D/S) Coma or unresponsive (C/U)Symptoms N V MHA SHA A&O A&C D/S C/URelative Risk 1.001 0.998 1.014 1.008 0.877 1.043 1.020 1.012

Symptom Screening Improves Accuracy of the FAST-ED Scale

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Symptom Screening Improves Accuracy of the FAST-ED Scale

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