Assessing the importance of arm Weakness as a symptom for urgency allocation and diagnosing TIA/Stroke in Out-of-Hours GP Services

Abstract

Background: Arm weakness is a common TIA/stroke symptom in the FAST mnemonic but can be difficult to recognise by patients. Rapid identification is crucial, as delayed treatment increases the risk of permanent brain damage. In the Netherlands, telephone triage with urgency allocation by nurses in the out-of-hours primary care (OHS-PC) setting is facilitated by the National Triage Standard (NTS). Aim: To examine the relationship between arm weakness and (i) urgency allocation and (ii) eventual diagnosis of TIA/stroke in patients reporting neurological deficits symptoms during telephone triage at the OHS-PC. Method: In the SAFETY-FIRST study, data which gathered retrospectively in patients who contacted between 2014 and 2017 one out of nine OHS-PC in the vicinity of Utrecht for neurological deficit symptoms. With univariable and multivariable logistic regression the relationship between arm weakness and (i) urgency allocation, and (ii) TIA/stroke diagnosis was assessed and crude and multivariate odds ratios (ORs) calculated. Results:, Of the 1,381 patients with neurological deficit symptoms, 367 (26.6%) reported arm weakness. Of those 303 (82.6%) were classified as high urgency; crude OR 2.6 (95% CI 1.9-3.5). After adjustment for age, gender, other ‘face, arm, speech time’ items, and a history of TIA/stroke, the adjusted OR was 1.2 (95% CI 0.63-2.24). Ultimately, 258 (70.3%) were diagnosed with a TIA/stroke; crude OR 2.7 (95%CI 2.1-3.5), adjusted OR 1.7 (95% CI 0.93-3.24), with similar results for women and men. Conclusion: Arm weakness as a single item results in a high urgency and has a high risk of TIA/stroke in patients with neurological deficit at the OHS-PC. However, after correction for age, gender, other FAST items, and a history of TIA, the relation was no longer significant.