Results: High-quality evidence was identified from one randomized controlled trial (RCT) regarding aspirin’s effect on mortality, complications, adverse effects due to bleeding, and incidence of cardiac arrest. Low- to very-low-quality evidence was identified from four other studies regarding the effect, but not timing, of aspirin administration on infarction size and early administration on cardiovascular mortality. No evidence was found regarding cardiac functional outcome or hospital length of stay.

Outcomes: Aspirin use showed benefits on mortality, complications, and cardiac arrest. No effect was noted on infarct size. Early administration (defined as prehospital or within the first hours of symptoms) showed a positive mortality benefit. Aspirin was found to increase minor bleeding risk.

Discussion: High-quality evidence supports administering aspirin to patients with chest pain due to suspected myocardial infarction (MI). Aspirin has been shown to decrease cardiovascular mortality, rates of complication secondary to MI, and cardiac arrest occurrence. While only low-quality evidence was found in regard to optimal timing of aspirin administration, early administration demonstrated a positive mortality benefit.

Recommendation: Early aspirin administration is recommended for all adults with chest pain due to suspected MI (weak recommendation, very-low-quality evidence).

Comment:

Dr. Sztajnkrycer: It must be clarified that the current recommendation (weak, very-low-quality evidence) solely examines the issue of timing of aspirin administration. The administration of aspirin in adults with chest pain suggestive of MI is a strong recommendation based upon high-quality evidence.

Stroke Recognition (FA 801)

Recommendation Author: Ann B. Smith, MD
Dr. Smith is a member of the Emergency Medicine Residency Training Class of 2018 at the Wake Forest School of Medicine.
Question: Among adults with suspected acute stroke (P), does the use of a rapid stroke scoring system or scale (I), compared with standard first aid assessment (C), change outcomes (O)?

Results: Six observational studies identified evaluated stroke systems on the outcome of time to treatment. For the outcome of recognition of stroke defined as diagnosis of stroke or administration of tissue plasminogen activator (tPA), four observational studies were identified. For the outcome of recognition of stroke defined as correct stroke diagnosis, 22 studies were evaluated to determine sensitivity and specificity of stroke scales. All studies but one (Harbison, 2003) were deemed low-quality evidence.

Outcomes: Two scales, Functional Assessment Staging Test (FAST) and Kurashiki Prehospital Stroke Scale (KPSS), resulted in decreased time from symptom onset to hospital arrival. Application of FAST resulted in increased stroke identification. Patients who had FAST or KPSS applied were more likely to receive thrombolytics. Inclusion of glucose measurement increased specificity of stroke assessment scales. All scales studied had a similar sensitivity, while scales that use glucose measurement (Los Angeles Prehospital Stroke Screen [LAPSS], Ontario Prehospital Stroke Screening [OPSS], KPSS, Recognition of Stroke in the Emergency Room [ROSIER]) had a higher specificity when compared with scales that do not (FAST, Melbourne Ambulance Stroke Screen [MASS], Los Angeles Motor Scale [LAMS], CPSS, Medical Priority Dispatch System [MPDS]).