院前急救电话对可疑急性脑卒中患者的快速筛选价值

The Value of Using the Face Arm Speech Time Scale in the Telephone Triage of Suspected Stroke Patients in Pre-hospital Emergency Care

目的:探讨院前急救时急诊医师通过电话使用面、臂、言语、时间评分量表(FAST)对可疑脑卒中患者进行快速筛选的价值。方法:急诊医师在院前急救中通过电话对可疑脑卒中患者参照FAST进行快速评估并转送,计算完成FAST评估所需的时间、灵敏度、特异度、准确度,阳性似然比、阴性似然比、相关系数和Kappa值。结果:本次研究中,急诊医师通过电话使用FAST对196例可疑脑卒中患者在院前急救中进行了快速评估和转送,平均耗时33秒,FAST的灵敏度74.78%、特异度67.90%、假阳性率32.10%、假阴性率25.22%、阳性似然比2.33、阴性似然比0.37、Kappa值0.425,准确度为71.94%;参考综合临床诊断,急诊医师可通过电话使用FAST对可疑脑卒中患者进行快速筛选,差异有统计学意义(P<0.05)。FAST对可疑脑卒中患者筛选结果的一致性为中高度一致。结论:在院前急救中,由急诊医师通过电话使用FAST对可疑脑卒中患者进行快速筛选有一定的价值。

Objective： To explore the value of using the Face Arm Speech Time（FAST） Scale in the telephone triage of suspected stroke patients in pre-hospital emergency care. Method： Emergency physicians prospectively used the FAST during telephone dispatch interview on suspected stroke cases got the pre-hospital emergency care,and the final diagnosis was made by consultant stroke physicians after assessment and review of clinical symptomatology and brain imaging findings. Calculated the FAST such as sensitivity（Se）,specificity（Sp）,positive likelihood radio（＋LR）,negative likelihood radio（-LR）,related coefficient（r） and Kappa value. Results：In the study,196 suspected stroke cases were assessed during telephone dispatch interview in pre-hospital emergency care by emergency physicians.The FAST showed a diagnostic Se74.78%, Sp67.90%,Fpr 32.10%, Fnr 25.22%, ＋LR2.33,-LR0.37,r 0.425 and kappa value 0.425.Consulted the final diagnosis, the FAST was useful on the recognition of suspected stroke patients during telephone dispatch interview in pre-hospital emergency care（P〈0.05）. Conclusions： The FAST is an useful stroke prehospital recognition tool by using telephone triage on the initial emergency call in assessment of suspect stroke cases.