We attempted to examine current ED triage priority screenings and identify potential strategies to decrease delays in the recognition, diagnosis, and treatment of posterior ischemic circulation strokes in patients presenting with atypical stroke symptoms. Our secondary aim was to identify interventions that can be implemented into current practice, improving patient outcomes.

Many recent studies have highlighted how the atypical presentation of ischemic posterior circulation strokes (IPCS) has led to an increase in diagnostic errors, poor outcomes, and increased mortality. These studies have attributed negative patient outcomes to an array of systemic failures and knowledge gaps.

Databases searched: PubMed, Embase, CINAHL. Search terms:  Posterior Stroke OR Posterior Circulation Stroke* AND emergency department AND misdiagnosis OR diagnostic errors, emergency medical services, triage, diagnosis, brain ischemia, ischemic stroke, ischemic posterior circulation stroke. Inclusion Criteria: published within the past 5 years in English, Ischemic strokes/ischemic posterior circulation strokes, males, females, adults 18 years or older. Exclusion Criteria: Hemorrhagic strokes, children 17 years or younger, transient ischemic attack

ED triage protocols are useful for categorizing patients by priority level based on immediate needs, but the atypical presentation of patients with IPCS typically results in lower priority categorization, which can result in worse outcomes. Having no known ED-triage tool specific for recognizing IPCS, further validates our research. 

While the FAST-ED scale, better known as face, arm, speech, time, is primarily used as a pre-hospital stroke screening tool, our findings suggest that with modifications, it could be utilized as an adjunct screening tool during ED-triage potentially improving outcomes for IPCS patients. FAST HAND-ED Triage Screening Tool incorporates the atypical symptoms associated with IPCS, such as ataxia (gait), nausea/vomiting, and dizziness/vertigo. While a large research study is needed to test our hypothesis, we conclude that a clinical tool should be incorporated to address patients associated with IPCS symptoms.