Accuracy of stroke identification by paramedics in a metropolitan pre-hospital setting: A cohort study

Teresa A. Williams, David Blacker, Glenn Arendts, Emily Patrick, Deon Brink, Judith Finn

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Introduction Acute stroke is a medical emergency. Identifying patients suffering a stroke is crucial if paramedics are to maximise delivery of appropriate management. One suggested screening tool to identify stroke is ‘FAST’ (Face, Arms, Speech, Time), but the accuracy of identifying pre-hospital stroke is unknown. Objectives We aimed to: a) examine how well stroke is identified by paramedics using the emergency department (ED) discharge diagnosis as the comparator; and b) assess compliance with ambulance clinical practice guidelines. Methods A retrospective cohort study was conducted in the Perth metropolitan area in Western Australia between July 2012 and June 2014 using linked data from ambulance and ED databases. Patients aged 45 years and over, transported to the ED by road ambulance and assigned the ambulance problem code or ED discharge diagnosis of stroke, were selected. Positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity were calculated. Text fields were examined for documentation that patients met FAST criteria. Results There were 2217 patients identified as stroke by paramedics. Of the 1834 patients identified as stroke in the ED, 958 were also identified as stroke by paramedics; 876 were not identified as stroke. Sensitivity for identification of stroke was 52.2%. Of the 2096 patients identified as stroke by paramedics and who had an ED record, PPV was 958/2096 (45.7%), NPV 99.5% and specificity 99.4%. Paramedics recorded two or three stroke signs and symptoms in 1137 (51%) patients. Conclusion Systematic assessment and documentation is needed to better identify patients with stroke in the pre-hospital setting.

Original languageEnglish
JournalAustralasian Journal of Paramedicine
Issue number2
Publication statusPublished - 2017
Externally publishedYes


  • Ambulance
  • FAST
  • Identification
  • Paramedic
  • Stroke
  • Stroke scales

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