An Integrative Review of the FAST, MASS and CPSS When Used in a Prehospital Setting
Lee, Michelle Nakyung
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Well-structured prehospital management is vital in acute stroke management to identify stroke quickly and accurately, and to administer the time-critical thrombolytic therapy. Utilisation of stroke screening tools is one of the important steps in prehospital acute stroke management to optimise health outcomes. There is a large volume of literature exploring the application, sensitivity and specificity of the prehospital stroke screening tools. Fast Arm Speech Test (FAST), Melbourne Ambulance Stroke Screening (MASS) and Cincinnati Prehospital Stroke Screen (CPSS) are three of the most commonly used screening tools in the United States, the United Kingdom, New Zealand and Australia. These are chosen for this integrative review because they have similar assessing components, but there is no integrative review comparing these three tools. This research follows the integrative literature review methodology to conduct research that focuses on the FAST, MASS and CPSS systematically. There is no literature solely focusing on the FAST, MASS and CPSS. Hence, these three prehospital stroke screening tools are chosen for this dissertation with the aim to review, update and reconceptualise the knowledge. The chosen literature is reviewed using the Joanna Briggs Institution (JBI) critical appraisal checklist to critically analyse research rigor and to see if there are any potential bias in research design, method and conduct. Through the thematic analysis, two themes are identified. Firstly, it is evident that EMD (emergency medical dispatcher) and EMS (emergency medical service) are the predominant users of the prehospital stroke screening tools. Secondly, the prehospital stroke screening is used for the purpose of triaging patients prior to hospital transfer, leading to either over or under-triage. This integrative review recommends increasing the awareness of stroke symptoms. This can be achieved by educating practitioners. Also, the need for more robust data on the prehospital stroke screening tool sensitivity and specificity is highlighted to aid prehospital practitioners to maintain evidence-based practice and be prepared for detecting stroke even when a patient displays atypical stroke symptoms.