Perbedaan Tingkat Akurasi Skala Face Arm Speech Test, Skala Los Angeles Pre-Hospital Stroke Screen, dan Skala Recognition of Stroke In The Emergency Room dalam Mengidentifikasi Pasien Stroke di Instalasi Gawat Darurat

Abstract

Background and Purpose Accurate identification of stroke is important and can expedite triage of patient to acute stroke unit and facilitate delivery of acute stroke therapies in hospital. The Face Arm Speech Test (FAST) is brief, reliable tool that is simple to administer. In the past, the Recognition of Stroke in Emergency Room (ROSIER) was not better than the FAST for recognition of stroke. The paramedics of Beijing used Los Angeles Pre-hospital Stroke Scale as a screening tool to identify stroke and also to exclude stroke mimics. Objective The objective of this study was to compare the diagnostic accuracy of FAST, LAPSS, ROSIER scale for Identification Stroke Patient in Emergency Room. Methods This cross sectional study involved 66 subjects of suspected stroke in emergency room. All subjects were examined for FAST, LAPSS, ROSIER scale , Head CT scan. Results The FAST showed sensitivity 76.2%, specificity 66.7%, Positive Predictive Value (PPV) 98%, Negative Predictive Value (NPV) 11.8%, Likelihood Rasio (LR)+ = 2.29, LR-= 0.36, Accuracy 76%. The LAPSS showed sensitivity 39.7%, specificity 66.7%, PPV 96.2%, NPV 5.0%, LR+ = 1.19, LR- = 0.9, Accuracy 41%. The ROSIER showed sensitivity 66.7%, specificity 66.7%, PPV 97.7%, NPV 8.7%, LR+ = 2.0, LR-= 0.5, Accuracy 67%. In Conciousness patient sensitivity were higher than before FAST 90.9% better than LAPSS 52.3% and ROSIER 86.4%. We excluded subject onset >24 hours sensitivity were higher than before, FAST (94.3%) better than LAPSS (74.3%) and ROSIER (88.6%) but Specificity LAPSS 100% better than FAST and ROSIER (50%). Accuracy FAST (91.9%) was better than LAPSS (74.3%) with p=0,99. Accuracy FAST better than ROSIER (86.5%) p=0.88 and Accuracy ROSIER better than LAPSS with p=0.98 Conclusion The FAST is better than LAPSS and ROSIER for identification stroke because of highest diagnostic accuracy with unsignificant difference. The comprehensive clinical and radiologic assessment is still important.