StrokeGuard: A Multi-Agent Guided System for Prehospital Stroke Assessment

Abstract

Prehospital stroke assessment aims to accurately identify stroke symptoms and make rapid decisions through standardized procedures within an extremely narrow time window, thereby saving valuable time for subsequent treatment. In clinical practice, FAST-based scales are widely used for prehospital stroke assessment by issuing instructions that guide subjects to perform specific actions to screen facial, arm, and speech functions. However, in home and community settings, non-clinical users often encounter challenges such as inaccurate descriptions, incomplete symptom observation, and difficult operational procedures, which may lead to inaccurate or biased assessment results. To address these challenges, this paper presents StrokeGuard: a multi-agent guided system designed for prehospital stroke assessment that makes mobile FAST screening more standardized and executable. Specifically, to overcome the limitations of traditional single-agent systems in terms of procedural fault tolerance and user guidance capability, StrokeGuard adopts a dual-channel agent mechanism that separates formal assessment (i.e., facial palsy, arm weakness, speech impairment) from procedural support (e.g., step prompts, error correction, and real-time feedback). It guides the assessment process through multi-agent collaboration, dual-channel interaction, state-machine control, and stage-local fallback recovery mechanisms. Stage-specific scoring is delegated to constrained pretrained video assessment modules, while evidence source records are integrated with structured report generation. The user evaluation uses MATES-9, an exploratory scale for measuring user experience in multistep AI-guided tasks. In a simulated prehospital scenario, StrokeGuard improves the MATES-9 total score over a paper FAST-style form by 10.83 points, corresponding to a 23.8% relative increase.