Table 3 Frequency of presenting symptoms not accounted for FAST With increasing stroke severity signs included in the FAST scheme were more prevalent (table 4). FAST signs were less frequent in TIA than in strokes (62.3% vs 81.5%). Severe strokes were nearly completely covered by FAST signs when a selleck NIH score of at least 6 was present. FAST signs occurred in 96.7% of patients who received thrombolysis. Table 4 Sings included in the FAST scheme depending on stroke severity, TIA or stroke and eligibility for thrombolysis Association between presenting symptoms and MRI lesions A
total of 1419 patients had no infarct in MRI, more than half of those patients (56.5%) had a TIA. From those 1419 patients only 65.1% were detected by the FAST items. For 252 patients no information about lesions in MRI was available. For patients with definite infarct lesions in MRI (n=2865) we tested
the differences in occurrence of symptoms included in the FAST scheme regarding vascular territories: FAST symptoms were less frequent in patients with strokes in the posterior circulation, where only 65.2% of all cases with an apparent MRI lesion could be identified, whereas 92.4% of anterior circulation strokes matched symptoms included in the FAST criteria. There was no difference between left and right hemispheric stroke (82.9% vs 82.1%). Hierarchy of presenting symptoms The item ‘arm/paresis’ was by far the most frequent sign in all patients with stroke (aged 18–55 years), and ‘speech’ the second (figure 2). Both items together were covering almost 75% of all recruited stroke and patients with TIA. Under hierarchic perspective the frequency of the ‘face’ item (0.2%) becomes irrelevant if the four most common signs of stroke ‘arm/paresis’ (57.7%), ‘speech’ (16.9%), ‘vertigo’
(10.6%) and ‘somatosensory deficit’ (6.8%) were prior sequentially used as selection criteria.13 14 Hemianopia occurred in general with a frequency of 14.4% but only 3.2% of the cases experienced this symptom Carfilzomib independent from arm/paresis, speech, vertigo or somatosensory deficits. Common stroke signs in young patients such as headache, leg paresis and diplopia were seldom or not independently differentiated from other stroke signs. Figure 2 Initial presenting symptoms (shown as a percentage of all cases). Discussion Principal findings Frequency of presenting symptoms In our cohort the FAST symptoms could be traced in 76.5% of all cases. This is notably less than in a previously reported study in which study nurses screened retrospectively the medical records of 3498 stroke cases who presented in an acute care hospital.4 The ‘capture rate’ in this study was 88.