Background: Adult Emergency Departments (ED) utilize a Rapid Stroke Screen (RSS) during triage to identify patients who may be experiencing a stroke. ED patients may present with vague symptoms, requiring a screen that is both sensitive and specific to ensure timely treatment without further straining an already burdened system. Our original RSS was not optimized to capture a subset of patients who were diagnosed with stroke during hospitalization. To improve detection, we revised our RSS to include sudden extremity numbness, dizziness/gait instability, a modified speech assessment, and a refined vision assessment targeting double vision and visual field loss. Emphasis was also placed on determining the last known well to better prioritize patients eligible for acute stroke intervention. Purpose: To evaluate whether adding extremity numbness, dizziness/gait instability, and a modified assessment for speech and vision to the existing RSS improves identification of acute stroke patients during ED triage. Methods: A retrospective chart review compared screening outcomes over two approximately 1-year periods (356 days): pre- and post-implementation of the revised RSS. The data set included all ED patients arriving by ambulance or walk-ins who were screened for stroke. Patients activated for stroke before arrival were excluded from this analysis. Stroke screens were categorized as positive or negative and reconciled against the final primary discharge diagnosis. Results: Pre-implementation, 243 patients were reviewed: 114 screened positive, 129 screened negative, with 144 having a final diagnosis of stroke. Post-implementation, 181 stroke patients were reviewed: 151 screened positive, 30 screened negative, with 108 having a diagnosis of stroke. The sensitivity of the screening tool increased from 0.49 to 0.83, indicating an improvement in the RSS's ability to identify patients experiencing a stroke. Additionally, the precision score improved from 0.62 to 0.72, representing a decrease in false positives. Lastly, there was a positive change in the F1 score from 0.55 to 0.77, further supporting the improvement of the new screen. Conclusion: The revised RSS provides a more comprehensive tool for identifying stroke patients during triage. Broadening the spectrum of symptoms improved the detection of true positives while reducing false positives. These improvements are critical for facilitating timely interventions within a busy and often chaotic healthcare system.
Freeman et al. (Thu,) studied this question.