Postgraduate Fellow: Mr Graham McClelland
Graham is a research paramedic, with many years of experience working at the North East Ambulance Service Foundation Trust. He is the first paramedic to be awarded a Stroke Association Postgraduate Fellowship.
Description of research
Aim of the research
The aim is to develop and test a new screening process that will give paramedics a probability rating, for individual patients, that stroke might not be the cause of their face, arm or speech problems.
Paramedics use the Face Arm Speech Test (FAST) to recognise stroke symptoms, but this does not necessarily mean that stroke is responsible. In fact, between 25-50% of FAST positive patients have a “stroke mimic” condition such as seizures. These “false positive” patients may still need urgent medical review. However, if they are transported to a stroke unit, the extra work could delay care for stroke patients and dilute the resources available for stroke care.
This project will analyse data from a regional ambulance service and hospitals. The aim is to determine the important clinical features that identify patients who have a mimic condition, even though they were FAST positive or thought by paramedics to have a stroke. This information will be combined with descriptions published about stroke mimic groups and the views of healthcare professionals to create a “mimic probability score”. Volunteer paramedics will complete the mimic probability score when they believe that stroke is the cause of a patient’s symptoms. This will be used to help determine whether it could be used in practice, and score results will be analysed to describe how often patients with mimic conditions might avoid admission to a stroke unit. The wider implications for patients and services will be predicted by statistical modelling and discussed in workshops with healthcare professionals.
If the mimic probability score appears to reduce the number of patients without stroke being admitted to specialist units, it will be offered to other regions for integration into their care pathway. We would plan a larger study to show whether better care is provided to stroke patients by reducing the distraction of other conditions.