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Tytuł:
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BE-FAST: A Sensitive Screening Tool to Identify In-Hospital Acute Ischemic Stroke.
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Autorzy:
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El Ammar F; Department of Neurology, University of Chicago, Chicago, Illinois.
Ardelt A; Department of Neurology, MetroHealth Medical Center, Cleveland, Ohio.
Del Brutto VJ; Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida.
Loggini A; Department of Neurology, University of Chicago, Chicago, Illinois.
Bulwa Z; Department of Neurology, University of Chicago, Chicago, Illinois.
Martinez RC; Department of Neurology, WellStar Health System, Marietta, Georgia.
McKoy CJ; Department of Neurology, University of Chicago, Chicago, Illinois.
Brorson J; Department of Neurology, University of Chicago, Chicago, Illinois.
Mansour A; Department of Neurology, University of Chicago, Chicago, Illinois.
Goldenberg FD; Department of Neurology, University of Chicago, Chicago, Illinois. Electronic address: .
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Źródło:
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Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2020 Jul; Vol. 29 (7), pp. 104821. Date of Electronic Publication: 2020 Apr 17.
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Typ publikacji:
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Comparative Study; Journal Article; Validation Study
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Język:
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English
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Imprint Name(s):
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Publication: Philadelphia, PA : Saunders
Original Publication: New York, NY : Demos Publications, [1991-
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MeSH Terms:
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Decision Support Techniques*
Emergency Service, Hospital*
Inpatients*
Neurologic Examination*
Brain Ischemia/*diagnosis
Intracranial Hemorrhages/*diagnosis
Ischemic Attack, Transient/*diagnosis
Stroke/*diagnosis
Aged ; Brain Ischemia/physiopathology ; Brain Ischemia/psychology ; Brain Ischemia/therapy ; Clinical Decision-Making ; Female ; Humans ; Intracranial Hemorrhages/physiopathology ; Intracranial Hemorrhages/psychology ; Intracranial Hemorrhages/therapy ; Ischemic Attack, Transient/physiopathology ; Ischemic Attack, Transient/psychology ; Ischemic Attack, Transient/therapy ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Reproducibility of Results ; Retrospective Studies ; Stroke/physiopathology ; Stroke/psychology ; Stroke/therapy ; Thrombolytic Therapy
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Contributed Indexing:
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Keywords: BE-FAST; Ischemic stroke; community-onset; in-hospital; stroke alert
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Entry Date(s):
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Date Created: 20200422 Date Completed: 20201005 Latest Revision: 20201005
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Update Code:
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20240105
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DOI:
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10.1016/j.jstrokecerebrovasdis.2020.104821
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PMID:
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32312632
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Background: Development of acute ischemic stroke in hospitalized patients represents a significant proportion of all cerebral ischemia. Several prehospital stroke scales were developed to screen for acute ischemic stroke in the community. Despite the advent of inpatient stroke alert systems, there is a lack of validated screening tools for the inpatient population. This study aims to assess the validity of BE-FAST (Balance, Eyes, Face, Arm, Speech, Time) as a screening tool for acute ischemic stroke among inpatients.
Methods: We retrospectively analyzed all stroke alert activations at a single academic medical center between 2012 and 2016. We classified the triggering symptom as: focal neurologic deficit, aphasia, dysarthria, ataxia/vertigo/dizziness, alteration of consciousness, acute confusion, or headache. BE-FAST was applied retrospectively, and patients were classified as BE-FAST positive or negative. The final diagnosis was classified as acute ischemic stroke, transient ischemic attack , intracranial hemorrhage or noncerebrovascular diagnosis.
Results: Of 1965 stroke alerts, 489 were among inpatients. The mean age was 63 ± 16.1 years; 57% of patients were women (n = 1121). Acute ischemic stroke was diagnosed in 29% of all the activations (n = 567), transient ischemic attack in 12% (n = 232), intracranial hemorrhage in 8 % (n = 160) and noncerebrovascular in 51% (n = 1006). When comparing inpatient with community-onset stroke alerts, the sensitivity of BE-FAST for diagnosing acute ischemic stroke was 85% versus 94% (P = .005), with a specificity of 43% versus 23% (P < .001), respectively. However, when evaluating in-patients with an intact level of consciousness separately, BE-FAST sensitivity for diagnosing acute ischemic stroke was 92% compared to 94% in the community (P = .579). Among in-patients with acute ischemic stroke who were (1) candidates for reperfusion therapy and (2) diagnosed with acute large vessel occlusion, the sensitivity of BE-FAST was 83% and 94%, respectively.
Conclusions: This is the first study to analyze the performance of BE-FAST among hospitalized patients evaluated through the inpatient stroke alert system. We found BE-FAST to be a very sensitive tool for screening for all in-hospital acute ischemic strokes, including inpatients that were candidates for acute reperfusion therapy.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
