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Neurological assessment with FAST to better detect posterior circulation stroke

02 July 2023
Volume 15 · Issue 7


Posterior circulation stroke (PCS) represents up to 25% of ischaemic strokes and affects more than 20 000 people annually within the UK. Prehospital clinical practice guidelines recommend the use of a validated stroke screening tool, such as the ‘Face, Arms, Speech, Time’ [FAST] tool for the assessment of all patients presenting with stroke symptoms. However, with PCS, patients may present with vestibular symptoms, which cannot be detected with ‘FAST’. Furthermore, over one-third of patients with PCS are delayed or misdiagnosed due to a lack of apparent ‘typical’ acute stroke symptoms. The ‘FAST’ tool is deemed to have high sensitivity and moderate specificity in the recognition of ischaemic stroke; yet there is evidence within the literature determining that the ‘FAST’ tool is not adequate for prehospital screening of PCS, leading to misdiagnosis, treatment delay, and severe life-limiting deficits or death. The aim of this literature search is to evaluate how the use of additional neurological assessment, alongside the validated ‘FAST’ tool, could be used within the prehospital setting for the improved paramedic detection of PCS.

Acute stroke is defined as a neurological disorder categorised by the sudden loss of blood flow to an area of the brain, resulting in the loss of neurological function. The three main classifications of acute stroke are ischaemic, haemorrhagic and transient ischaemic (Kuriakose et al, 2020). National Institute for Health and Care Excellence (NICE) (2023) clinical guidelines state that acute stroke is the leading cause of death and disability, affecting more than 100 000 people and the cause of 38 000 deaths within the UK each year. The aetiology of stroke is influenced by detrimental lifestyle factors resulting in hypercholesterolaemia, leading to atherosclerosis and hypertension; patients diagnosed with cardiac arrhythmias have an increased risk of embolisms leading to acute stroke (NICE, 2022).

Posterior circulation stroke (PCS) accounts for up to 25% of ischaemic strokes and affects more than 20 000 people annually in the UK (Banerjee et al, 2018). Affecting the brain stem structures supplied by the vertebrobasilar arterial system, PCS is caused by a narrowing or blockage of one or more of the arteries that supply the brainstem, which can result in vestibular symptoms (Gulli et al, 2009). Patients presenting with PCS symptoms in the prehospital setting require the same emergency admission to hospital as those with other classifications of acute stroke (Association of Ambulance Chief Executives (AACE), 2023).

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