Screening Tool for Large Vessel Occlusion Strokes (LVOS)?
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
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.
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]
