Via: Neurology Update 29 Nov 2011 written by Michael Woodhead.
An “in the field” stroke screening tool used by ambulance staff may boost thrombolysis rates from the typical 3% to around 50% of patients with ischaemic stroke, an NSW program has shown.
The pre-hospital stroke triage protocol developed by the John Hunter Hospital in Newcastle has been successfully adopted for use in other hospitals to help alert and prepare a stroke team and improve “door to needle” times, a study (link) in Journal of Clinical Neuroscience shows.
The protocol known as FASTER (Face, Arm, Speech, Time, Emergency Response) is based on pre-hospital checks of arm function and speech in patients who have had onset of stroke symptoms within the last two hours.
This allows an on-call stroke team to be alerted, and the patient is fast tracked through the ED for stroke evaluation.
In the first six months following the introduction of the protocol, 42 patients were referred via the FASTER pathway, and 50% of them received tpA.
The study authors say the protocol not only resulted in significantly faster ED door-to-needle times, but also patients were admitted to the Stroke Unit over an hour faster than those receiving tPA prior to use of the protocol, due to rapid clinical and radiological assessments.
The stroke screening protocol also had a high accuracy of stroke diagnosis with only two of 42 referrals (<5%) found to be stroke mimics.
Response to article from Kelvin Hill Manager of the Clinical Guidelines Program “Improved ambulance and acute hospital processes lead to stroke patients getting best practice care recommended in the National Stroke Guidelines.”