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Field Assessment of Critical Stroke by Emergency Services for Acute Delivery to a Comprehensive Stroke Center: FACE2AD

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A Correction to this article was published on 08 January 2020

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Abstract

Patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) should be triaged to an endovascular-capable hospital by the emergency medical service (EMS). We designed a prehospital LVO prediction scale based on EMS assessments. In the derivation cohort, 1157 patients transferred to our hospital by the EMS because of suspected stroke within 24 h of onset were retrospectively examined. Factors associated with AIS due to LVO were identified based on the EMS assessment, and a prehospital scale identifying LVO was developed. The accuracy of this scale was validated in 502 consecutive patients who were transferred to 4 stroke centers, and its accuracy was compared with those of 4 previously reported scales. AIS due to LVO was diagnosed in 149 of 1157 patients (13%) in the derivation cohort. One point each was assigned for facial palsy, arm weakness, consciousness impairment (cannot say his/her name), atrial fibrillation, and diastolic blood pressure ≤ 85 mmHg, with two points for conjugate eye deviation (FACE2AD scale). In the derivation cohort, with the optimal cut-point of FACE2AD ≥ 3 determined by the area under the curve (AUC; 0.88; 95% confidence interval 0.87–0.90), sensitivity, specificity, positive predictive value, and negative predictive value for FACE2AD to predict LVO were 0.85, 0.80, 0.39, and 0.97, respectively. In the validation cohort, the FACE2AD scale had higher accuracy, with an AUC value of 0.84 for predicting LVO compared with the other scales (all p < 0.01). The FACE2AD scale is a simple, reliable tool for identifying AIS due to LVO by the EMS.

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Change history

  • 08 January 2020

    The original version of this article unfortunately contained mistakes.

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Acknowledgments

We thank paramedics at Suita city fire department, Mino city fire department, Toyonaka city fire department, Ibaraki city fire department, Ikeda city fire department, Settsu city fire department, Toyooka city fire department, Nantan fire department, Mikata broader-based fire department, Kobe city department, and Nara wide area fire department.

Funding

This study was supported in part by the Intramural Research Fund for Cardiovascular Diseases of National Cerebral and Cardiovascular Center (H26-4-1).

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Authors and Affiliations

  1. Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan

    Yoshinori Okuno, Kazuyuki Nagatsuka & Masafumi Ihara

  2. Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan

    Hiroshi Yamagami

  3. Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan

    Hiroharu Kataoka & Jun C Takahashi

  4. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan

    Yoshio Tahara

  5. Department of Neurology, Nara City Hospital, Nara, Japan

    Shuichi Tonomura

  6. Department of Neurosurgery, Nara City Hospital, Nara, Japan

    Hidemori Tokunaga

  7. Department of Neurosurgery, Toyooka Hospital, Toyooka, Japan

    Taichiro Imahori

  8. Emergency & Critical Care Medicine, Tajima Emergency & Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Hyogo, Japan

    Daisaku Matsui & Makoto Kobayashi

  9. Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan

    Hirotoshi Imamura & Nobuyuki Sakai

  10. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan

    Kazunori Toyoda

Authors
  1. Yoshinori Okuno
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  2. Hiroshi Yamagami
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  3. Hiroharu Kataoka
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  4. Yoshio Tahara
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  5. Shuichi Tonomura
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  6. Hidemori Tokunaga
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  7. Taichiro Imahori
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  8. Daisaku Matsui
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  9. Makoto Kobayashi
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  10. Hirotoshi Imamura
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  11. Nobuyuki Sakai
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  12. Jun C Takahashi
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  13. Kazunori Toyoda
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  14. Kazuyuki Nagatsuka
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  15. Masafumi Ihara
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Corresponding author

Correspondence to Hiroshi Yamagami.

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The original version of this article was revised: The figure captions were incorrect.

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Okuno, Y., Yamagami, H., Kataoka, H. et al. Field Assessment of Critical Stroke by Emergency Services for Acute Delivery to a Comprehensive Stroke Center: FACE2AD. Transl. Stroke Res. 11, 664–670 (2020). https://doi.org/10.1007/s12975-019-00751-6

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  • DOI: https://doi.org/10.1007/s12975-019-00751-6

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