A Diagnosis Study of a New Prehospital Strokeidentification Test, the PreHospitalt Ambulans Stroke Test (PreHAST), to be Used to Triage Patients With Suspected Stroke (Pre-HAST)

A Validation Study of a Structured Diagnostic Examination of Patients With Suspected or Confirmed Stroke Resulting in a Stroke Score

The aim of the Pre-HAST study is to improve identification and triage of patients with suspected stroke in order to get the right patient to the right level of care as fast as possible. Furthermore, the scale is also intended to use follow stroke symptoms in emergency care. The test is more extensive then the FAST or Cincinatti Stroke Scale and is in some aspects similar to the NIHSS but is shorter, easier and faster to perform to improve interexaminator variability and improve validity in less trained personal. The test is intended for awake patients with suspected stroke

Study Overview

• Status: Completed
• Conditions: Stroke
• Intervention / Treatment: Other: Standardized neurological examination

Detailed Description

PreHAST (PreHospital Ambulance Stroke Test)

• for suspected stroke in awake patients The following parameters are tested.

  1. Commands • Evaluates ability to understand verbal commands (impressive aphasia?) and to carry out complex commands (apraxia?)

     • Give the command: open and close your eyes! Grip your hand! (non-paretic side) 0 - two correct 2 - one or none correct

  2. Eye position • Evaluates involuntary deviation of the gaze (déviation conjugée?). If present, this implies a serious injury and thus 2 p are given.

     • Observ if the patient have the eyes trained to one direction unmotivated 0 - normal 2 - Patient gaze in one direction only or preferably

  3. Visual field

     • The test should be conducte in both left and right visual field simulatneously to evaluate both if hemianopsia and/or negelct are present. Both symptoms implieas a sever injury and thus 2 p are given

     • Look the patient in the eyes and wave in both visual fields simultaneously. Ask the patient to point at the hand or hands waving.

       0 - normal 2 - Only distinguishes one hand

  4. Facial palsy Ask the patient to smile 0 - normal 1 - one side of the mouth is hanging

  5. Arm paresis Is tested in lying or sitting position, one arm at the time. Start with the strongest arm. Lift the arm 45 degrees and ask the patient to keep in the position for 10 s. Count audible. If the patient can't lift the arm, assist.

     If the inability to keep the arm elevated is due to pain - score 0 Right Left 0 - can maintain the arm in postition for 10 s 1 - The arm drifts down from the initial position within 10 s but does not rely on support 2 - Falls down to support within 10 s or directly

  6. Leg paresis Test in lying or sitting position, one leg at the time. Start with the strongest leg. Lift the leg 30 degrees and ask the patient to keep in the position for 10 s. Count audible. If the patient can't lift the leg, assist.

     If the inability to keep the leg elevated is due to pain - score 0 Right Left 0 - can maintain the leg in position for 5 s 1 - The leg drifts down from the initial position within 5 s but does not rely on support 2 - Falls down to support within 5 s or directly

  7. Sensory (pain)

     • Evaluation of eventual loss of sensory function. It is important that pain is tested as not to miss a serious and not too uncommon type of stroke localized in the brain stem (Wallenberg´s syndrome).

     • Pinch the bend of the arms and legs, respectively. The stimuli shall be done simultaneously at the left and right side. Ask the patient if he/she can feel the stimuli in the same way on both sides. If the patient only registers stimuli on one side, 2 p are given.

       0 - normal

       1 - registers stimuli on both sides but less on one side 2 - Only registers the stimuli on one side

  8. Language • Evaluate if the patient has an understandable speech as stroke can cause both slurred speech (dysarthria) and affected ability to find words (aphasia). This test does not distinguish between dysarthria or dysphasia . Patient who does not speak at all (is mute) is given 2 p.

     • Ability to talk is noted during the examination. If uncertain, ask the patient to repeat: "the weather is pretty today" 0 - Normal 1 -Slight or moderate dysartria or aphasia. Communication possible. 2 - Severe dysarthria or aphasia. Communication basically not possible.

• Study Type: Observational
• Enrollment (Actual): 78

Contacts and Locations

Study Locations

• Sweden
  • Stockholm, Sweden
    • Södersjukhuset
  • Skåne
    • Hässleholm, Skåne, Sweden
      • Pre hospital services in Skåne, Sweden

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients with suspected stroke using pre hospital services in region Skåne, Sweden or being admited to Södersjukhuset in Stockholm, Sweden

Description

Inclusion Criteria:

• Suspected stroke

Exclusion Criteria:

• Unconscious

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Suspected stroke; Patients with suspected stroke who are evaluated by paramedics	Other: Standardized neurological examination

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
stroke diagnosis	The Pre-HAST is performed in the ambulance, in the emergency room or in the acute stroke ward. Final diagnosis of stroke and imaging data is matched to the findings in the Pre-HAST test	within 2 weeks of recrutiment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
neuroimaging findings of large vessel oclusion	Imaging findings of examined patients are reviewed	within 3 months

Collaborators and Investigators

• Sponsor: Karolinska Institutet
• Collaborators: Lund University

Publications and helpful links

General Publications

• Andsberg G, Esbjornsson M, Olofsson A, Lindgren A, Norrving B, von Euler M. PreHospital Ambulance Stroke Test - pilot study of a novel stroke test. Scand J Trauma Resusc Emerg Med. 2017 Apr 11;25(1):37. doi: 10.1186/s13049-017-0377-x.

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2014
• Primary Completion (ACTUAL): May 1, 2014
• Study Completion (ACTUAL): January 1, 2020

Study Registration Dates

• First Submitted: September 9, 2014
• First Submitted That Met QC Criteria: September 14, 2020
• First Posted (ACTUAL): September 18, 2020

Study Record Updates

• Last Update Posted (ACTUAL): September 18, 2020
• Last Update Submitted That Met QC Criteria: September 14, 2020
• Last Verified: September 1, 2020

More Information

Terms related to this study

• Keywords: stroke pre hospital identification TIA; Patients with suspected stroke; Ability to give informed consent
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Stroke
• Other Study ID Numbers: Pre-HAST