Published online before print December 2, 2002, doi: 10.1161/01.STR.0000044170.46643.5E
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2003;34:71.)
© 2003 American Heart Association, Inc.
Original Contributions |
Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test
From Freeman Hospital Stroke Service (J.H., O.H., J.D., S.J.L., G.A.F.), Newcastle General Hospital, Newcastle upon Tyne, and Royal Bournemouth and Christchurch Hospitals NHS Trust Stroke Service (D.J.), Bournemouth, UK
Correspondence to Prof G.A. Ford, Wolfson Unit of Clinical Pharmacology, University of Newcastle upon Tyne, NE2 4HH, UK. E-mail g.a.ford{at}ncl.ac.uk
Background and Purpose— Timely referral of appropriate patients to acute stroke units is necessary for effective provision of skilled care. We compared the characteristics of referrals with suspected stroke to an academic acute stroke unit via 3 primary referral routes: ambulance paramedics using a rapid ambulance protocol and stroke recognition instrument, the Face Arm Speech Test; primary care doctors (PCDs); and emergency room (ER) referrals.
Methods— Patient characteristics, final diagnosis, and admission delay were recorded in all suspected acute stroke referrals in a 6-month period.
Results— Four hundred eighty-seven patients (356 strokes/transient ischemic attacks) were admitted by the 3 routes: 178 by ambulance, 216 by PCDs, and 93 through the ER. The proportion of nonstrokes admitted by each route was similar (23%, 29%, and 29%, respectively). Ambulance paramedics’ stroke diagnosis was correct in 144 of 183 (79%) stroke patients who initially presented to them. Thirty-nine of 66 strokes/transient ischemic attacks referred via ER were taken there following initial ambulance assessment. Compared with PCDs, paramedics referred more total anterior circulation (39% versus 14%, P<0.0001) and fewer lacunar strokes (14% versus 31%, P<0.001) and admitted more patients (46% versus 12%, P<0.01) within 3 hours of symptom onset. The most common nonstroke conditions were seizures, infections and confusion, cardiovascular collapse, and cerebral tumors. Paramedics admitted more patients with seizures.
Conclusions— Misdiagnosis of stroke is common in the ER and by PCDs. Paramedics using the Face Arm Speech Test achieved high levels of detection and diagnostic accuracy of stroke.
Key Words: ambulances • diagnosis • emergency medical services • emergency treatment • primary health care • stroke • triage
This article has been cited by other articles:
 |
|
 |
|
  W. Whiteley, M.-C. Tseng, and P. Sandercock Blood Biomarkers in the Diagnosis of Ischemic Stroke: A Systematic Review Stroke, October 1, 2008; 39(10): 2902 - 2909. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. McCormick, I. Reeves, T. Baird, I. Bone, and K. W. Muir Implementation of a stroke thrombolysis service within a tertiary neurosciences centre in the United Kingdom QJM, April 1, 2008; 101(4): 291 - 298. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Simon Acute stroke in primary care InnovAiT, April 1, 2008; 1(4): 299 - 304. [Full Text] [PDF]
|
|
|
|
 |
|
 R I Lindley Commentary on NICE guidelines for alteplase for the treatment of acute ischaemic stroke Heart, December 1, 2007; 93(12): 1617 - 1618. [Full Text] [PDF]
|
|
|
|
|
|
S. Roebers, M. Wagner, M. A. Ritter, F. Dornbach, K. Wahle, and P. U. Heuschmann Attitudes and Current Practice of Primary Care Physicians in Acute Stroke Management Stroke, April 1, 2007; 38(4): 1298 - 1303. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Shellhaas, S. E. Smith, E. O'Tool, D. J. Licht, and R. N. Ichord Mimics of Childhood Stroke: Characteristics of a Prospective Cohort Pediatrics, August 1, 2006; 118(2): 704 - 709. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. K. Moser, L. P. Kimble, M. J. Alberts, A. Alonzo, J. B. Croft, K. Dracup, K. R. Evenson, A. S. Go, M. M. Hand, R. U. Kothari, et al. Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke: A Scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council Circulation, July 11, 2006; 114(2): 168 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N U Weir and A M Buchan A study of the workload and effectiveness of a comprehensive acute stroke service J. Neurol. Neurosurg. Psychiatry, June 1, 2005; 76(6): 863 - 865. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K M McPherson and P Kersten Knowledge and action in stroke--are either good enough? Qual. Saf. Health Care, June 1, 2004; 13(3): 166 - 167. [Full Text] [PDF]
|
|
|
|
|
|
A. M. Nor, C. McAllister, S.J. Louw, A.G. Dyker, M. Davis, D. Jenkinson, and G.A. Ford Agreement Between Ambulance Paramedic- and Physician-Recorded Neurological Signs With Face Arm Speech Test (FAST) in Acute Stroke Patients Stroke, June 1, 2004; 35(6): 1355 - 1359. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Broderick William M. Feinberg Lecture: Stroke Therapy in the Year 2025: Burden, Breakthroughs, and Barriers to Progress Stroke, January 1, 2004; 35(1): 205 - 211. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Wiborg and B. Widder Teleneurology to Improve Stroke Care in Rural Areas: The Telemedicine in Stroke in Swabia (TESS) Project Stroke, December 1, 2003; 34(12): 2951 - 2956. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Lees Stroke Is Best Managed by a Neurologist: Battle of the Titans Stroke, November 1, 2003; 34(11): 2764 - 2765. [Full Text] [PDF]
|
|
|
|
 |
|
 Stroke Referrals from Ambulance Staff vs. from Primary Care, ER Journal Watch Neurology, March 27, 2003; 2003(327): 3 - 3. [Full Text]
|
|