Prehospital Stroke Assessment and Management Systems
Summary
Prehospital stroke assessment and management systems encompass a coordinated set of practices, technologies and protocols designed to identify, triage and expedite the care of individuals exhibiting acute cerebrovascular events before they reach hospital. The principal aim is to compress the interval between symptom onset and definitive treatment, thereby maximising the likelihood of favourable neurological recovery. Key components include emergency medical dispatcher recognition, standardised clinical scales applied by ambulance clinicians, telemedicine support, and prehospital notification of receiving stroke centres. Advances in digital health—such as mobile applications for stroke scales, automated speech and text algorithms for call‐centre triage, and real‐time video consultation—are reshaping the chain of survival. These systems integrate training and decision support tools to improve sensitivity and specificity in stroke recognition, to reduce on‐scene time, and to ensure optimal routing of patients to centres capable of rapid reperfusion therapies. Globally, the adoption of regional stroke networks and performance monitoring has highlighted disparities in access and outcomes, underscoring the need for continuous system refinement and evaluation.
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Prehospital Stroke Assessment and Management Systems publication trend
The graph below shows the total number of articles in prehospital stroke assessment and management systems across all publications each year (not limited to Nature Index journals).
Technical terms
National Institutes of Health Stroke Scale (NIHSS): A systematic tool for quantifying neurological deficits in stroke, covering domains such as consciousness, gaze, motor function and language, traditionally used in hospital but increasingly adapted for prehospital use via mobile devices.
Face, Arm, Speech Test (FAST): A rapid, mnemonic‐based stroke screening scale used by prehospital clinicians and public education campaigns to detect key stroke signs—facial droop, arm weakness and speech disturbances.
Balance, Eyes, Face, Arm, Speech, Time (BEFAST): An extension of FAST that includes balance and visual symptoms to improve detection of posterior circulation strokes.
Telemedicine: The remote delivery of clinical services using telecommunications technology, such as video links, to support diagnosis and decision‐making between on‐scene emergency providers and hospital specialists.
Prenotification: The process by which emergency medical services alert a stroke centre in advance of patient arrival, enabling the hospital team to prepare imaging and treatment pathways ahead of time.
References
- A retrospective study on machine learning-assisted stroke recognition for medical helpline calls. npj Digital Medicine (2023).
- Video support for prehospital stroke consultation: implications for system design and clinical implementation from prehospital simulations. BMC Medical Informatics and Decision Making (2024).
- Experiences from a cluster‐randomized trial (ParaNASPP) exploring triage and diagnostic accuracy in paramedic‐suspected stroke: a qualitative interview study. European Journal of Neurology (2024).
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