We found that 14% of patients with acute stroke would be missed using FAST alone, and this proportion was reduced to 4.4% with addition of a history of gait and visual symptoms (BE-FAST). A stroke is when the blood supply to the brain is restricted or cut off. It is used to help detect symptoms of stroke. The benefit of the administration of intravenous tissue-type plasminogen activator or endovascular clot retrieval in patients with acute ischemic stroke decreases as the time between symptom onset and treatment increases.1,2 Public knowledge of stroke symptoms, however, is generally poor.3 Although several screening tools have been developed to help the public identify persons having an acute stroke to facilitate their rapid access to medical care, the FAST mnemonic (Face, Arm, Speech, Time) has been adopted by the American Heart Association and is one of the most commonly publicized.4 An initial study found that FAST has an 88% sensitivity for the identification of carotid artery distribution strokes with 77% of those without FAST symptoms having strokes in the vertebrobasilar distribution.4 Subsequent work found that FAST identified 69% to 90% of strokes but missed up to 40% of those with posterior circulation events.5–7 Rates improved with the addition of visual symptoms and limb ataxia, but ataxia can be difficulty to identify.6 Some educational programs have used the mnemonic BE-FAST, adding a “B” for balance and an “E” for eyes, but supportive data are limited. E - Eyes Is the person experiencing suddenly blurred or double vision or a sudden loss of vision in one or both eyes? F.A.S.T. Compared with those who were BE-FAST symptom or examination positive, those without any of these symptoms or findings did not differ by sex but were younger and had less severe neurological impairments based on the NIHSS score (Table). Of 858 consecutive records identified, 736 met inclusion criteria; 14.1% did not have any FAST symptoms at presentation. Compared with those who were FAST symptom or examination positive, those without any of these symptoms or findings did not differ by sex but again tended to be younger (P=0.0511) and have less severe neurological impairments based on the NIHSS score (Table). Because the sample was limited to patients with a confirmed stroke, it was not possible to calculate the specificity of BE-FAST. The FAST algorithm (Face, Arm, Speech, Time) helps identify persons having an acute stroke. Unfortunately, too often lay persons delay in calling 911 or use a private vehicle to transport a patient with stroke symptoms. If you think someone may be having a stroke, act F.A.S.T. Statistical analysis was performed using JMP software (SAS Institute, Cary, NC) and MedCalc (MedCalc Software bvba, Ostend, Belgium). An NIHSS score of 3 or 4 for arm or leg is considered a severe deficit. Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of weakness or numbness in 1 arm. The stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms. The “F” stands for face. Has their mouth drooped? Ask the person to smile. If validated in a prospective study, a revision of public educational programs may be warranted. The most common scale used in the hospital setting is the NIHSS. 1-800-AHA-USA-1 F ace: Smile and see if one side of the face droops. A stroke occurs when the blood supply to an area of the brain is cut off. A more simple way to identify a stroke victim is the “FAST test.” This test is an easy way to remember the most common signs of stroke. The symptoms depend upon the region of the brain that is affected by the loss of blood supply and can include changes in sensation or motor control. This acronym can help remind you to “act fast” when a stroke is happening—to you, a loved one, or even a stranger on the street. Treating a stroke is a race against time to save brain tissue and potentially the stroke victim’s life. ; Feel—is there a severe headache?) A trend suggested a reduction in strokes missed restricted to the vertebrobasilar circulation among those who were BE-FAST symptom or examination positive (47%; P=0.11). Is the person’s smile uneven? More complex scores do not result in better diagnostic performance. ; Reach, is one side weak or numb? The acronym stands for Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services. It is better to seek treatment and find out that it is not a stroke than to “wait and see” and risk brain damage or death. © American Heart Association, Inc. All rights reserved. is an easy way to quickly identify the early warning signs of a stroke. Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ask the person to smile. use prohibited. In a sensitivity analysis, face weakness, arm weakness, or speech impairment on the admission NIHSS examination were considered in addition to a history of FAST symptoms. In a sensitivity analysis, if face weakness, arm weakness, or speech impairment on the admission NIHSS examination were considered in addition to a documented history of FAST symptoms, the proportion of stroke patients who would be missed was reduced from 14.1% to 9.9% (z=3.29; 95% confidence interval, 7.9–12.3; P=0.0010); 68% of these missed strokes were restricted to the vertebrobasilar circulation. FAcE DROOPIng — Does one side of the face droop or is it numb? Receiving timely stroke treatment is an important step to recovery. A test that examines facial weakness, arm weakness, and speech disturbance allows paramedics to identify stroke quickly and accurately, researchers report in the April 30 issue of Stroke.The study found that paramedics who used the Face Arm Speech Test (FAST) were in close agreement with neurologists using the National Institute of Health Stroke Scale in early recognition of stroke. SPEEch DIFFIculTy — Is speech slurred? Those misclassified, having missing National Institutes of Health Stroke Scale data, or were comatose or intubated were excluded. The FAST test helps to spot the three most common symptoms of stroke. The proportion missed that were limited to the vertebrobasilar circulation was reduced to 43% with BE-FAST (P=0.042). Ask the person to smile Ask them to … Learn more about National Stroke Awareness month and the F.A.S.T. E-mail. Unauthorized We determined the proportion of patients with acute ischemic stroke not captured by FAST and evaluated a revised mnemonic. The second part of the FAST PLUS test evaluates only the presence of severe arm or leg motor deficit (scored 0–1). campaign encourages everyone to learn the key signs of stroke and to think F.A.S.T., act fast and look out for each other by calling 111 if they suspect a stroke. The proportions of patients missed based on FAST was compared with the proportion missed after inclusion of gait-related (gait imbalance or lower extremity weakness) or visual (visual loss and diplopia) symptoms (ie, balance/leg weakness [B] and vision, eyes [E]; BE-FAST). The use of FAST and ABCD2 scores in posterior circulation, compared with anterior circulation, stroke and transient ischemic attack. and do the following simple test: Acute stroke intervention: a systematic review. F - Face Drooping Does one side of the face droop or is it numb? Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. After a stroke occurs, there is no way to repair the brain injury that has already occurred, and this leads to permanent disability or death. Local Info F.A.S.T. F is for Face: A classic stroke symptom is a … B.E. Of those patients who were FAST symptom negative, the most common presenting symptoms were gait imbalance (33%)/leg weakness (10%), visual impairment (visual loss, diplopia, or blurring; 40%), headache (16%), and dizziness (8%); 70% of these patients had symptoms of either a gait abnormality/leg weakness or a visual impairment (either alone [29%] or in combination with other non-FAST symptoms). Most of the stroke awareness initiative in this country is aimed at the identification of anterior strokes; most famously with the FAST mnemonic (Face drop, Arm droop, Speech disturbance). The vascular distributions of strokes missed on FAST was determined based on review of magnetic resonance imaging brain reports. The FAST test may be a useful tool for prehospital identification of stroke/TIA but has limitations as the test can have false negatives and false positives. Contact Us, Reducing the Proportion of Strokes Missed Using the FAST Mnemonic, Correspondence to Larry B. Goldstein, MD, Department of Neurology, University of Kentucky, 740 S Limestone St, L445, Lexington, KY 40536. FAST is an acronym to help you quickly recognize the warning signs and symptoms of stroke. Perhaps no acronym is more fitting for stroke detection and treatment than F-A-S-T. can identify more strokes than FAST (99.9% versus 88.9%), they are more difficult to remember.5,9 A simple modification of the FAST mnemonic (BE-FAST) could reduce the proportion of missed strokes while reinforcing the essential public health message. 1-800-242-8721 Many of the more commonly used stroke scales are not designed to identify posterior circulation strokes . Although there was no difference based on sex, those with strokes missed by FAST tended to be younger and had less severe deficits than those identified by FAST. The inclusion of gait/leg and visual symptoms leads to a reduction in missed strokes. FAST-AV or FAST-AB tool improves the sensitivity of FAST screening for detection of posterior circulation strokes. Is the person unable to speak or hard to understand? F for Face: You should check his or her face. Customer Service The gait impairment or visual loss identified with BE-FAST can, however, lead to important disabilities that may be appropriate for acute intervention.10. In a sensitivity analysis, if face weakness, arm weakness, or speech impairment on admission examination were considered in addition to a history of FAST symptoms, the proportion missed was reduced to 9.9% (P=0.0010). T = Time: If any of the above symptoms are present, you must call 911 immediately in order to make sure that this person reaches the hospital fast. The sooner somebody who is having a stroke … So recognising the signs of stroke and calling 999 for an ambulance is crucial. Of those who were FAST symptom and examination negative, the proportion of stroke patients who would not have been identified was reduced with the addition of a history of gait imbalance/leg weakness or visual impairment (BE-FAST, 2.5%; z=6.66; 95% confidence interval, 1.56–4.00; P<0.0001). Act FAST to Recognize the Signs of a Stroke Medically reviewed by Seunggu Han, M.D. organization. That means when asking a person to smile, you should pay attention to any asymmetry in their face. Continuous variables were compared with a t test, ordinal data with a Mann–Whitney U test, categorical variables with a χ2 test, and proportions with a z test. A rms: Raise both arms. FAST is an acronym used as a mnemonic to help detect and enhance responsiveness to the needs of a person having a stroke. – Signs of Stroke Should Prompt FAST Action A sensitivity analysis in which findings on initial examination were considered in addition to historic symptoms, however, did not substantially alter the results. The F.A.S.T. Presenting symptoms, demographics, and examination findings based on the NIHSS were abstracted.8. Consistent with previous reports, the majority of strokes (71%) missed using FAST involved the vertebrobasilar circulation.4,6,7 Although more extensive symptom recognition tools such as Give Me 5 for Stroke (Walk, is balance off? The acronym FAST (Facial drooping, Arm weakness, Speech difficulties and Time) has been used by the National Stroke Association, American Heart Association and others to educate the public on detecting symptoms of a stroke. These blood vessels supply the parts of the brain that control our motor function and muscle movements. The FAST test is good for detecting a stroke in the anterior circulation. https://doi.org/10.1161/STROKEAHA.116.015169, National Center If validated in a prospective study, a revision of public educational programs may be warranted. The 14.1% of stroke patients who would not have been identified by FAST alone was reduced to 4.4% with the addition of these 2 symptoms (BE-FAST; z=7.62; 95% confidence interval, 2.99–6.098; P<0.0001). Those misclassified, having missing National Institutes of Health Stroke Scale (NIHSS) data, or were comatose or intubated were excluded. Because the study was performed at a single tertiary care center, the proportion of strokes missed may be different in other settings. ; See, is vision all or partly lost? BE-FAST could capture >95% of ischemic strokes. Use the FAST test to check for the most common symptoms of a stroke in yourself or someone else.