Comparison of Two Pre-Hospital Stroke Scales to Detect Large Vessel Occlusion Strokes in Australia: A Prospective Observational Study

Aims The Hunter-8 and the ACT-FAST are stroke scales used in Australia for the pre-hospital identification of large vessel occlusion (LVO) stroke but have not previously been compared. Moreover, their use in identifying distal arterial occlusions has not previously been assessed. We therefore aimed to describe the area under the receiver operating curve (AUC) of the Hunter-8 versus the ACT-FAST for the detection of classic LVO. Methods Both scales were performed on consecutive patients presenting with stroke-like symptoms within 24 hours of symptom onset presenting to the emergency department at a tertiary referral hospital between June 2018 and January 2019. The AUC of the Hunter-8 and the ACT-FAST was calculated for the detection of LVO using different definitions [classic LVO (proximal segment of the middle cerebral artery (MCA-M1), terminal internal carotid artery (T-ICA), or tandem occlusions) and extended LVO (classic LVO plus proximal MCA-M2 and basilar occlusions)]. Results Of 126 suspected stroke patients, there were 24 classic LVO and 34 extended LVO. For detection of classic LVO, the Hunter-8 had an AUC of 0.79 and the ACT-FAST had an AUC of 0.77. For extended LVO, the AUC was 0.71 and 0.70 respectively. Conclusion Both scales represent a significant opportunity to identify patients with proven potential benefit from thrombectomy (classic LVO), however M2 and basilar occlusions may be more challenging to identify with these scales.