The Importance of Accurate Stroke Identification

Oct 13, 2025 by wbrum.org 148 views

Differences in the Accuracy Level of Face Arm Speech Test, the Scale of the Los Angeles Pre-Hospital Stroke Screen, and the Scale of Recognition of Stroke in the Emergency Room in Identifying Stroke Patients in the Emergency Department Installation

Introduction

The accurate identification of stroke patients is crucial in accelerating medical treatment in hospitals, particularly in the placement of acute stroke units and the delivery of stroke therapy needed. Various tools are used to detect strokes, including the Face Arm Speech Test (FAST), the Los Angeles Pre-Hospital Stroke Scale (LAPSS), and the Recognition of Stroke in Emergency Room (ROSIER). Each scale has a distinct approach and accuracy in detecting patients with this condition. This article aims to discuss the accuracy comparison of the three scales and provide a more in-depth analysis.

The Importance of Accurate Stroke Identification

Accurate stroke identification is vital in ensuring timely and effective treatment. The use of the right tool in an emergency situation can save lives and prevent further damage due to stroke. The consequences of delayed or incorrect diagnosis can be severe, leading to increased morbidity and mortality rates. Therefore, it is essential to evaluate the effectiveness of each scale in identifying stroke patients.

Research Methodology

A cross-sectional study was conducted involving 66 subjects suspected of having a stroke in the emergency department. All subjects were tested using FAST, LAPSS, and ROSIER, and a CT scan examination was carried out to ensure diagnosis. The results of each of these tools provided information about sensitivity, specificity, and accuracy in identifying stroke patients.

Research Results

Based on the data obtained:

Face Arm Speech Test (FAST) shows a sensitivity of 76.2% and specificity of 66.7%, with a positive predictive value (PPV) of 98% and negative predictive value (NPV) of 11.8%. The overall accuracy reached 76%.
Los Angeles Pre-Hospital Stroke Scale (LAPSS) has a lower sensitivity of 39.7%, but the specificity also reaches 66.7%. The PPV of LAPSS is 96.2% with a very low NPV of 5.0%, resulting in an accuracy of only 41%.
Recognition of Stroke in Emergency Room (ROSIER) showed a sensitivity of 66.7% and specificity of 66.7% as well, with a PPV of 97.7% and NPV of 8.7%. The overall accuracy reaches 67%.

When evaluating conscious patients, FAST sensitivity increased to 90.9%, which was far better than LAPSS (52.3%) and ROSIER (86.4%). When excluding the subject with onset of symptoms of more than 24 hours, the sensitivity of FAST increased to 94.3%, outperforming LAPSS (74.3%) and ROSIER (88.6%). However, LAPSS shows higher specificity (100%) compared to FAST and ROSIER (50%).

In terms of accuracy, FAST (91.9%) is superior to LAPSS (74.3%) with p = 0.99, and is better than ROSIER (86.5%) with p = 0.88. Meanwhile, ROSIER's accuracy is also higher than LAPSS with p = 0.98.

Conclusion

From the analysis that has been done, it can be concluded that Face Arm Speech Test (FAST) is the most effective tool for identifying stroke patients compared to Los Angeles Pre-Hospital Stroke Scale (LAPSS) and Recognition of Stroke in Emergency Room (ROSIER). FAST has the highest level of accuracy even though the existing difference is not statistically significant. The importance of comprehensive clinical evaluation and radiological assessment is still needed, given the complexity and variability of stroke conditions.

With a better understanding of the effectiveness of each scale, medical personnel can improve the stroke identification process and, in turn, increase patient care results. The use of the right tool in an emergency situation can save lives and prevent further damage due to stroke.

Implications for Practice

The findings of this study have significant implications for practice. Medical personnel should use FAST as the primary tool for identifying stroke patients in the emergency department. However, it is essential to note that FAST should be used in conjunction with comprehensive clinical evaluation and radiological assessment to ensure accurate diagnosis. The use of LAPSS and ROSIER should be limited to situations where FAST is not feasible or available.

Limitations of the Study

This study has several limitations. The sample size was relatively small, and the study was conducted in a single emergency department. Future studies should aim to recruit a larger sample size and conduct the study in multiple emergency departments to increase the generalizability of the findings.

Future Research Directions

Future research should focus on evaluating the effectiveness of other stroke identification tools and developing new tools that can improve the accuracy of stroke diagnosis. Additionally, studies should aim to investigate the factors that contribute to the variability in stroke diagnosis and develop strategies to improve the consistency of diagnosis.

References

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Tables and Figures

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Appendices

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Frequently Asked Questions (FAQs) about the Differences in the Accuracy Level of Face Arm Speech Test, the Scale of the Los Angeles Pre-Hospital Stroke Screen, and the Scale of Recognition of Stroke in the Emergency Room in Identifying Stroke Patients in the Emergency Department Installation

Q: What is the Face Arm Speech Test (FAST)?

A: The Face Arm Speech Test (FAST) is a simple and quick test used to identify stroke patients in the emergency department. It involves checking for facial weakness, arm weakness, and speech difficulties.

Q: What is the Los Angeles Pre-Hospital Stroke Scale (LAPSS)?

A: The Los Angeles Pre-Hospital Stroke Scale (LAPSS) is a tool used to identify stroke patients in the pre-hospital setting. It involves assessing the patient's level of consciousness, speech, and motor function.

Q: What is the Recognition of Stroke in Emergency Room (ROSIER)?

A: The Recognition of Stroke in Emergency Room (ROSIER) is a tool used to identify stroke patients in the emergency department. It involves assessing the patient's level of consciousness, speech, and motor function.

Q: What are the differences in the accuracy level of FAST, LAPSS, and ROSIER?

A: The study found that FAST has the highest level of accuracy (76%) compared to LAPSS (41%) and ROSIER (67%). However, the existing difference is not statistically significant.

Q: Which tool is best for identifying stroke patients?

A: Based on the study, FAST is the most effective tool for identifying stroke patients compared to LAPSS and ROSIER.

Q: What are the limitations of the study?

A: The study has several limitations, including a small sample size and a single emergency department setting.

Q: What are the implications for practice?

A: The findings of the study have significant implications for practice. Medical personnel should use FAST as the primary tool for identifying stroke patients in the emergency department.

Q: What are the future research directions?

A: Future research should focus on evaluating the effectiveness of other stroke identification tools and developing new tools that can improve the accuracy of stroke diagnosis.

Q: What are the factors that contribute to the variability in stroke diagnosis?

A: The study did not investigate the factors that contribute to the variability in stroke diagnosis. However, future studies should aim to investigate this further.

Q: How can medical personnel improve the stroke identification process?

A: Medical personnel can improve the stroke identification process by using the right tool in an emergency situation, such as FAST, and by conducting comprehensive clinical evaluation and radiological assessment.

Q: What are the benefits of using the right tool in an emergency situation?

A: The use of the right tool in an emergency situation can save lives and prevent further damage due to stroke.

Q: What are the consequences of delayed or incorrect diagnosis?

A: The consequences of delayed or incorrect diagnosis can be severe, leading to increased morbidity and mortality rates.

Q: How can medical personnel ensure accurate diagnosis?

A: Medical personnel can ensure accurate diagnosis by using the right tool, conducting comprehensive clinical evaluation and radiological assessment, and by following established protocols.

Q: What are the key takeaways from the study?

A: The key takeaways from the study are that FAST is the most effective tool for identifying stroke patients, and that medical personnel should use the right tool in an emergency situation to ensure accurate diagnosis.

Q: What are the future implications of the study?

A: The study has significant future implications for the development of new stroke identification tools and for improving the accuracy of stroke diagnosis.

Q: How can the study be applied in real-world settings?

A: The study can be applied in real-world settings by medical personnel using FAST as the primary tool for identifying stroke patients in the emergency department.

Q: What are the potential applications of the study?

A: The study has potential applications in the development of new stroke identification tools and in improving the accuracy of stroke diagnosis.

Q: What are the potential limitations of the study?

A: The study has several potential limitations, including a small sample size and a single emergency department setting.

Q: How can the study be replicated?

A: The study can be replicated by conducting a larger study with a more diverse sample size and by using multiple emergency departments.

Q: What are the potential future directions of the study?

A: The study has several potential future directions, including evaluating the effectiveness of other stroke identification tools and developing new tools that can improve the accuracy of stroke diagnosis.