• Endovascular intervention for acute ischemic stroke from ICA or proximal MCA occlusion is a Level IA recommendation¹.
• Identification of patients who may benefit from endovascular intervention begins in the prehospital setting.
• Several prehospital stroke scales exist, but have not been validated using arterial imaging to determine the presence of LVOS.
• The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale (see Table 1) was designed based on items of the NIH Stroke Scale (NIHSS) with higher predictive value for LVOS.

• The FAST-ED scale has comparable accuracy to predict LVOS to the NIHSS, and higher accuracy compared to the Rapid Arterial Occlusion Evaluation (RACE) and the Cincinnati Prehospital Stroke Severity (CPSS) scale
• The FAST-ED scale also provides 3 distinct groups for the likelihood of LVOS:
  • Score 0 or 1: <15%
  • Score 2 or 3: 30%
  • Score >= 4: >60%

Bottom Line: Additional assessment of gaze deviation, aphasia and neglect, as included in the FAST-ED scale, increases the accuracy of predicting LVOS.  

References

1. Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020-35.
2. Lima FO, Silva GS, Furie KL, et al. Field Assessment Stroke Triage for Emergency Destination: A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes. Stroke. 2016 Jun 30. [Epub ahead of print]

 

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