PracticeUpdate Neurology Best of 2018

CONFERENCE COVERAGE 18

International Stroke Conference 2018 24–26 JANUARY 2018 LOS ANGELES, CALIFORNIA, USA By the PracticeUpdate Editorial Team

© American Heart Association/ISC 2018

Training EmergencyMedical Service Staff in Simple Test Helps Improve Identification of Posterior Stroke The findings highlight the potential of prehospital providers to advance stroke care through improved recognition and triage of acute stroke patients, says study author. T eaching emergency medical services (EMS) to use the finger-to-nose (FTN) test in patients with neurological and less rapidly than patients with ante- rior strokes.”

After a 12-month period collecting base- line data, all paramedics working in the county received a 30-minute online training module that targets recognition of stroke symptoms. In addition, paramedics from one of the three EMS agencies working in the region also received in-person training on performing the FNT test. The investi- gators then compared the rate at which EMS personnel were able to identify pos- terior strokes before and after the training intervention. Overall, 777 ischemic stroke cases were transported by EMS during the 21-month study period. Of these, 139 (18%) were posterior circulation strokes. Before train- ing was initiated, the EMS personnel from the agency that received the FTN

He pointed out that patients with posterior circulation strokes are less likely to pres- ent with unilateral weakness or difficulty speaking, the hallmark of an anterior circu- lation stroke. They are more likely instead to have vague symptoms, such as dizzi- ness, imbalance, loss of coordination, or visual disturbances. Dr. Oostema and colleagues identified all consecutive ischemic stroke cases that were transported by any of three EMS agencies in a single county in southwest- ern Michigan over a 21-month period. Each stroke was classified as being anterior, pos- terior, or indeterminate, based on the final hospital discharge diagnosis.

symptoms can contribute to early detection of posterior circulation strokes, according to a poster presented at ISC 2018. “We noticed a large proportion of EMS- missed stroke cases in a previous study were in the posterior circulation,” pre- senter John A. Oostema, MD, of Michigan State University College of Human Medi- cine and Spectrum Health in Grand Rapids, Michigan, told Elsevier’s PracticeUpdate . “Strokes in this area may present with different symptoms than strokes in the anterior circulation. Perhaps as a result, patients with posterior stroke receive tis- sue plasminogen activator (tPA) less often

PRACTICEUPDATE NEUROLOGY