Work

Implementation and Validation of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) in a Rural EMS Region

Year: 2025

Type: article

Abstract: Objectives Prehospital identification of large vessel occlusion (LVO) stroke patients is crucial for timely mechanical thrombectomy (MT). The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score effectively predicts LVOs, but its utility in rural, multi-state emergency medical services (EMS) systems remains unexplored.Methods This prospective cohort study included ground prehospital stroke alerts in Vermont, New Hampshire, and Maine from July 2021 to December 2022. Patients with a prehospital FAST-ED score recorded were enrolled. LVO was confirmed by CT angiography. Our primary outcome was the accuracy of LVO identification with FAST-ED scores. Secondary outcomes included the predictiveness of the prehospital FAST-ED score for Thrombectomy Capable Center (TCC) appropriateness, MT, and 30-day mortality.Results This study included 370 patients. The overall LVO prevalence was 23.2% (n = 86). A positive FAST-ED score demonstrated a sensitivity of 73% (95% CI, 63%-82%) and specificity of 61% (95% CI, 55%-66%) for presence of LVO. The PPV was 36% (95% CI, 29%-44%) and the NPV was 88% (95% CI, 83%-92%). Positive FAST-ED scores were associated with significantly higher rates of TCC appropriateness (46% vs 10%, p < 0.0001), mechanical thrombectomy (19% vs 6%, p < 0.001) and 30-day mortality (24% vs 6%, p < 0.001).Conclusions The FAST-ED score can be implemented by prehospital personnel to triage patients to a TCC when faced with options for hospital destination in a rural setting. This study supports incorporating FAST-ED scoring in rural protocols for potential diversions to TCCs. Further research should be done to better characterize the effects of prehospital diversion on time to thrombectomy, functional outcomes, and mortality.

Source: Prehospital Emergency Care

DOI: 10.1080/10903127.2025.2498012