Accuracy of Stroke Diagnosis Using FAST (Face, Arm, Speech, Time) Tool by Emergency Medical Service Dispatchers and Technicians and its Impact on Transport Time

Objectives: This study aimed to determine the accuracy of the Face-Arm-Speech-Time (FAST) screening tool used by emergency medical dispatchers (EMDs) and emergency medical technicians (EMTs) for the diagnosis of acute stroke and its effect on the patient’s transfer time from the scene to the hospital.Methods: This study was conducted retrospectively during a one-year period. Via census sampling, we recruited all patients over۱۸-years-old diagnosed with acute stroke whether by EMDs or by EMTs. Pre-hospital operation forms and hospital records were used for data gathering. Final diagnoses were finally determined according to the patients’ brain magnetic resonance imaging (MRI).Results: Totally, ۱,۲۸۰ patients with a mean age of ۶۴.۱ _ ۱۷.۸ years were studied, of whom, ۷۳۰ were men (۵۷%). Accordingly, ۱,۰۱۶ probable cases of stroke (۷۹.۴%) were reported by EMDs, while only ۵۴۳ cases (۴۲.۴%) were reported as suspected cases of stroke by EMTs at the scene of the incident. Ultimately, stroke wasconfirmedin ۵۱۹ (۴۰.۵%) cases. Accordingly, the Area under the curves (AUCs) for EMDs and EMTs were ۰.۵۰ (۰.۴۸ to ۰.۵۳) and ۰.۷۴ (۰.۷۱ to ۰.۷۶), respectively. Transport time (TT) was shorter if the initial diagnosis of stroke was made by EMTs. The TT was marginally significant and patients with stroke diagnoses were transported to the hospital faster than others (۱۷.۳_۱۱.۵ vs. ۱۸.۵_۱۱.۹ min; P = ۰.۰۶۵).Conclusions: The use of FAST by EMTs for detecting probable acute stroke has acceptable sensitivity and specificity; but when it is used by EMDs, it has higher sensitivity and very low specificity. The diagnosis of stroke by EMTs may lead to faster transport to the hospital.

Keywords:

Early Diagnosis , Emergency Medical Services , Patient Transfer , Stroke