Evaluate the impact of multidisciplinary process improvements and FAST-ED score stratification on neurointerventional team activation, resource optimization and decreasing neurointerventional thrombectomy times.
Timely intervention in acute ischemic stroke (AIS) is essential for improving outcomes. Activating neurointerventional resources in non-large vessel occlusion (LVO) cases can create inefficiencies. The FAST-ED score, a validated prehospital tool for predicting LVOs, offers a way to streamline team mobilization and reduce Door to Puncture times.
FAST-ED scores were added to initial stroke code pages. Viz.ai’s AI platform converted pre-hospital alerts into “pager cards.” Scores ≥5 prompted core stroke team members to expand the card to include neurointerventional radiology (NIR). If CTA ruled out LVO, the team was stood down via the same card. Countermeasures included:
FAST-ED score stratification enabled targeted activation of neurointerventional teams, avoiding unnecessary mobilization in 122 true negative cases (FAST-ED≤4 AND no LVO). The collective countermeasures led to a 37.61% reduction in median door-to-puncture time (113 to 71 minutes, resulting in a statistically significant, p<0.001. FAST-ED score performance metrics were: True Negatives (TN) = 122, True Positives (TP) = 5, False Positive (FP) =6, False Negatives (FN) = 1, yielding a sensitivity of 83.33% and specificity of 95.31%.
Integrating FAST-ED scoring into EMS and hospital workflows was associated with improved procedural efficiency and resource utilization. After adding the FAST-ED score to our workflow, we saw a 37.61% decrease in door-to-puncture times. This points towards the added benefit of using prehospital stroke severity scales in angiography team activation. Future studies are necessary to better quantify the added benefit of prehospital stroke scale use in acute stroke treatment.