moFASTER: A novel triage tool to improve identification of posterior circulation cerebrovascular events
Academic Emergency Medicine
Background: Approximately 25% of the 795,000 acute ischemic strokes diagnosed yearly in the United States involve the posterior circulation. Given the time- sensitive nature of our available therapies for these patients, many EDs use triage tools such as the Cincinnati Prehospital Stroke Scale (CPSS) or the Los Angeles Prehospital Stroke Screen (LAPSS) to rapidly identify and prioritize these patients. Unfortunately, these tools are neither designed to identify posterior circulation strokes (PCVAs) nor validated for use in the ED. The downstream effect of this inadequate triage is that PVCA patients, whose presentations are somewhat atypical, can be misdiagnosed and/or under-treated. Our objective was to create a novel ED-based stroke triage tool which would capture acute ischemic strokes including PCVAs. Methods: We conducted a retrospective observational trial at our 95,000 visit community hospital ED to describe the ability of our novel mo FASTER triage tool to increase the percentage of patients diagnosed with a PCVA. At our institution, the standard of care was to use the CPSS to guide the triage of these patients. Baseline data were collected from all adult (age > 18 y/o) ED patients with an acute ischemic stroke for a three month period in 2016, compared to a three month period in 2017 following the implementation of the moFASTER triage tool. To confirm the accuracy of the tool, patients were excluded from the analysis if their diagnosis of an acute stroke was not based on neuroimaging, either CT or MRI. Our primary outcome measure was the difference in the number of ED identified PCVAs after implementation moFASTER compared to the baseline. Data were analyzed using descriptive statistics and Fisher’s Exact to test for significance. Results: A total of 251 ED patients were included in the study, 130 in the baseline cohort and 121 in the moFASTER cohort. During the baseline data collection period, 24 patients (18.5%) had a confirmed PCVA on neuroimaging. After moFASTER was implemented, 38 patients (31.4%) had a confirmed PCVA on neuroimaging. This represented a statistically significant difference with a Fisher’s exact of 0.0195. Conclusion: Implementation of the moFASTER ED triage tool significantly improved identification of PCVAs at our institution.
Chung S, Rocchini A, Shimke S, Jones S, Anderson W, Bastani A. moFASTER: a novel triage tool to improve identification of posterior circulation cerebrovascular events. Acad Emerg Med 2019; 26: S235-S236.