Befast stroke
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BEFAST vs. FAST: Enhancing Stroke Detection and Public Awareness
Introduction to Stroke Detection Mnemonics
Stroke detection is crucial for timely treatment and improved outcomes. Two primary mnemonics used for public education and prehospital stroke detection are FAST (Face, Arm, Speech, Time) and BEFAST (Balance, Eyes, Face, Arm, Speech, Time). While FAST has been widely endorsed, BEFAST includes additional symptoms to capture posterior circulation strokes, potentially increasing detection accuracy.
Diagnostic Accuracy of BEFAST and FAST
Sensitivity and Specificity in Acute Ischemic Stroke
A systematic review and meta-analysis comparing FAST and BEFAST in acute ischemic stroke (AIS) patients revealed that BEFAST has a higher diagnostic value. The sensitivity of FAST was 0.77, while BEFAST had a sensitivity of 0.68. However, BEFAST showed higher specificity (0.85) compared to FAST (0.60), indicating that BEFAST may reduce false positives and improve diagnostic accuracy.
Prehospital Stroke Detection
In a prospective study of emergency response activations, BEFAST and FAST were compared for stroke detection accuracy. The study found that both scales had comparable accuracy, with BEFAST showing an area under the curve (AUC) of 0.70 and FAST an AUC of 0.69. However, BEFAST had a higher negative predictive value (NPV) of 0.93 compared to FAST's 0.86, suggesting BEFAST may be more reliable in ruling out non-stroke cases.
Public Education and Awareness
Utilization by Comprehensive Stroke Centers
An analysis of public educational materials from US Comprehensive Stroke Centers (CSCs) showed that 58% of CSCs listed BEFAST, while 35% listed FAST. This indicates a growing preference for BEFAST in public education, particularly in western and southeastern states. The study highlights the need for consistent public messaging to improve stroke symptom recognition .
Social Media Campaigns
The #BEFASTChallenge, a social media campaign using dance videos to promote stroke symptom awareness, demonstrated the feasibility of reaching a large audience at a low cost. The campaign garnered significant engagement, with 13,821 views and numerous interactions across platforms like Facebook, Twitter, and Instagram. This suggests that innovative approaches can effectively raise public awareness about stroke symptoms.
In-Hospital Stroke Detection
BEFAST as a Screening Tool for Inpatients
A study assessing BEFAST's validity as a screening tool for in-hospital acute ischemic stroke found it to be highly sensitive. BEFAST had a sensitivity of 85% for diagnosing acute ischemic stroke among inpatients, which increased to 92% for those with an intact level of consciousness. This underscores BEFAST's utility in both community and hospital settings for timely stroke detection.
Conclusion
The BEFAST mnemonic, by including balance and eye symptoms, offers a more comprehensive approach to stroke detection compared to FAST. It shows higher specificity and reliability in various settings, from prehospital to in-hospital environments. Public education campaigns and innovative social media strategies further enhance stroke symptom awareness, potentially leading to better outcomes through timely intervention.
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