Accuracy of paramedic identification of stroke and transient ischemic attack in the field

Abstract

Paramedics in San Francisco County were correct three-fourths of the time when their documentation listed patients as having stroke/TIA. However, they did not identify 39% of stroke victims, a patient population who may benefit from urgent therapy. A substantial period elapses before stroke victims access 911. This highlights the need to develop an educational program for the community at risk for stroke, and another for paramedics directed toward more accurate identification of acute stroke victims.

Assessment of Stroke Patients’ Status and Their Transfer Time by Emergency Medical Services to Valiasr Hospital in Arak City, Iran

“…However, According to some authors, diagnosis accuracy reported as 72% by Kothari, 40% by Ramanujam and with utilization [34,35,48,53,54]. Therefore, poor diagnosis of stroke patients accounts for increase in pre-hospital delay, on the other hand, correct diagnosis of stroke reduces mortality and disability in patients [55].…”

Developing a community paramedic practitioner intermediate care support scheme for older people with minor conditions

“…Previous studies have shown that paramedic skills can be increased to assess and treat certain conditions in the community such as wounds, 6 cervical spine injury, 7 and stroke. 8 A study by in the UK has evaluated the use of "treat and refer" protocols for minor conditions by ambulance staff. 9 This allowed them to leave appropriate patients on scene with referral or self care advice.…”

EMS Management of Acute Stroke—Prehospital Triage (Resource Document to NAEMSP Position Statement)

“…To optimize stroke identification in the field, prehospital professionals should be competent in the use of a prehospital stroke screening instrument that has been prospectively evaluated for sensitivity, specificity, reproducibility, and validity. 27−30 The sensitivity of paramedic identification of stroke patients unaided by a formal screening algorithm has varied between 61% and 72% 27,31 However, the use of a prehospital stroke assessment instrument has been shown to markedly increase paramedic sensitivity to stroke identification in the field. Two common prehospital stroke instruments, the Los Angeles Prehospital Stroke Screen (LAPSS) and the Cincinnati Prehospital Stroke Scale (CPSS), have both demonstrated sensitivities of greater than 90% 29,32,33 In addition, the more recent Melbourne Ambulance Stroke Screen (MASS), which is an amalgamation of the CPSS and LAPSS, has also shown a sensitivity of 90%.…”