Stroke Clinical Trial
Official title:
A Validation Study of a Structured Diagnostic Examination of Patients With Suspected or Confirmed Stroke Resulting in a Stroke Score
The aim of the Pre-HAST study is to improve identification and triage of patients with suspected stroke in order to get the right patient to the right level of care as fast as possible. Furthermore, the scale is also intended to use follow stroke symptoms in emergency care. The test is more extensive then the FAST or Cincinatti Stroke Scale and is in some aspects similar to the NIHSS but is shorter, easier and faster to perform to improve interexaminator variability and improve validity in less trained personal. The test is intended for awake patients with suspected stroke
PreHAST (PreHospital Ambulance Stroke Test)
- for suspected stroke in awake patients The following parameters are tested.
1. Commands • Evaluates ability to understand verbal commands (impressive aphasia?)
and to carry out complex commands (apraxia?)
• Give the command: open and close your eyes! Grip your hand! (non-paretic side) 0
- two correct 2 - one or none correct
2. Eye position • Evaluates involuntary deviation of the gaze (déviation conjugée?).
If present, this implies a serious injury and thus 2 p are given.
• Observ if the patient have the eyes trained to one direction unmotivated 0 -
normal 2 - Patient gaze in one direction only or preferably
3. Visual field
- The test should be conducte in both left and right visual field simulatneously
to evaluate both if hemianopsia and/or negelct are present. Both symptoms
implieas a sever injury and thus 2 p are given
- Look the patient in the eyes and wave in both visual fields simultaneously.
Ask the patient to point at the hand or hands waving.
0 - normal 2 - Only distinguishes one hand
4. Facial palsy Ask the patient to smile 0 - normal 1 - one side of the mouth is
hanging
5. Arm paresis Is tested in lying or sitting position, one arm at the time. Start with
the strongest arm. Lift the arm 45 degrees and ask the patient to keep in the
position for 10 s. Count audible. If the patient can't lift the arm, assist.
If the inability to keep the arm elevated is due to pain - score 0 Right Left 0 -
can maintain the arm in postition for 10 s 1 - The arm drifts down from the initial
position within 10 s but does not rely on support 2 - Falls down to support within
10 s or directly
6. Leg paresis Test in lying or sitting position, one leg at the time. Start with the
strongest leg. Lift the leg 30 degrees and ask the patient to keep in the position
for 10 s. Count audible. If the patient can't lift the leg, assist.
If the inability to keep the leg elevated is due to pain - score 0 Right Left 0 -
can maintain the leg in position for 5 s 1 - The leg drifts down from the initial
position within 5 s but does not rely on support 2 - Falls down to support within 5
s or directly
7. Sensory (pain)
- Evaluation of eventual loss of sensory function. It is important that pain is
tested as not to miss a serious and not too uncommon type of stroke localized
in the brain stem (Wallenberg´s syndrome).
- Pinch the bend of the arms and legs, respectively. The stimuli shall be done
simultaneously at the left and right side. Ask the patient if he/she can feel
the stimuli in the same way on both sides. If the patient only registers
stimuli on one side, 2 p are given.
0 - normal
1 - registers stimuli on both sides but less on one side 2 - Only registers
the stimuli on one side
8. Language • Evaluate if the patient has an understandable speech as stroke can cause
both slurred speech (dysarthria) and affected ability to find words (aphasia). This
test does not distinguish between dysarthria or dysphasia . Patient who does not
speak at all (is mute) is given 2 p.
- Ability to talk is noted during the examination. If uncertain, ask the patient
to repeat: "the weather is pretty today" 0 - Normal 1 -Slight or moderate
dysartria or aphasia. Communication possible. 2 - Severe dysarthria or
aphasia. Communication basically not possible.
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