Finger-to-Nose Test May Refine Prehospital Stroke Recognition

By David Douglas

August 17, 2019

NEW YORK (Reuters Health) - Adding the finger-to-nose (FTN) test to standard screening may better help paramedics to recognize posterior circulation ischemic stroke, according to findings from a small study.

"While this was a pilot study and thus our findings are preliminary, the finger-to-nose test showed promise in helping paramedics identify stroke in the back of the brain more accurately," Dr. J. Adam Oostema of Michigan State University College of Human Medicine, in Grand Rapids, told Reuters Health by email.

"It may be useful in the prehospital or emergency department triage settings where catching these often difficult-to-identify patients may expedite their care," he added.

Compared with patients with anterior stroke, those with ischemic stroke in the posterior circulation are less likely to show unilateral weakness and may present with nonspecific symptoms, such as dizziness and altered mental status, Dr. Oostema and colleagues explain in Stroke, online August 6.

In addition, they note, "screening tools such as the Cincinnati Prehospital Stroke Scale rely on unilateral motor deficits, which preferentially identify anterior strokes."

To evaluate what difference addition of the FTN test might make, the researchers gave in-person FTN instruction to all 146 paramedics at a single emergency-medical-services agency. Paramedics at two other agencies without such training acted as controls.

Over the course of 21 months, 51 posterior circulation stroke patients were transported by the FTN agency and 88 by the control agencies.

After training, posterior stroke recognition rose from 46% to 74%, a significant improvement, whereas there was no change in the control agencies (32% and 39%).

Mean door-to-CT time also dropped significantly from 62 to 41 minutes, but there was no change in controls (58 and 61 minutes). There was no difference in alteplase delivery across agencies.

The researchers concede that their research has a number of limitations, but conclude that, "If confirmed by a larger study, this simple training could meaningfully enhance care for patients with posterior circulation ischemic stroke."

Dr. Clare L. Atzema, an emergency physician at Sunnybrook Health Sciences Centre, in Toronto, Canada, told Reuters Health by email, "These very preliminary results are certainly intriguing. While in the emergency department the finger-to-nose test has not proved very useful at differentiating these particular strokes (posterior circulation strokes) from other medical causes of patients' symptoms, if this . . . test improved detection of these strokes in the prehospital setting it could potentially reduce patient disability and even mortality."

"However," concluded Dr. Atzema, who was not involved in the study, "these findings must be replicated in other studies before we can draw any conclusions, and we also need to assess whether there is an associated increase in 'false alarms' (calling a posterior stroke where there isn't one), which could lead to an increase in complications of (unnecessary) treatment and resource use."


Stroke 2019.