Befast stroke aha
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Summary
8 papers analyzed
These studies suggest that BEFAST has a higher diagnostic value than FAST for acute ischemic stroke and is more sensitive, but consistency in public messaging and the addition of coordination and diplopia assessments do not improve detection.
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Comparing FAST and BEFAST Mnemonics for Stroke Recognition
Introduction to Stroke Recognition Mnemonics
Stroke recognition is crucial for timely treatment and improved outcomes. Two primary mnemonics used in public education for stroke symptoms are FAST (Face, Arm, Speech, Time) and BEFAST (Balance, Eyes, Face, Arm, Speech, Time). The American Heart Association (AHA) and American Stroke Association (ASA) endorse these tools to help the public quickly identify stroke symptoms and seek immediate medical attention .
Diagnostic Accuracy of FAST vs. BEFAST
Sensitivity and Specificity
A systematic review and meta-analysis comparing FAST and BEFAST in acute ischemic stroke (AIS) patients revealed that BEFAST has a higher diagnostic value than FAST. The sensitivity of FAST was found to be 0.77, while BEFAST had a sensitivity of 0.68. However, BEFAST showed higher specificity at 0.85 compared to FAST's 0.60. The area under the ROC curve was also higher for BEFAST (0.86) than for FAST (0.76), indicating better overall diagnostic performance.
Prehospital Setting Performance
In a prospective study of emergency response activations, BEFAST and FAST were compared for stroke detection accuracy. The study found that both mnemonics had similar accuracy, with BEFAST showing an area under the curve (AUC) of 0.70 and FAST an AUC of 0.69. The positive predictive value (PPV) was slightly lower for BEFAST (0.49) compared to FAST (0.53), but BEFAST had a higher negative predictive value (NPV) of 0.93 versus 0.86 for FAST. Another study confirmed these findings, showing that while BEFAST increased sensitivity by including balance and eye assessments, it did not significantly improve overall stroke detection accuracy.
Public Education and Awareness
Utilization by Comprehensive Stroke Centers
A study analyzing the use of FAST and BEFAST mnemonics in public education by US Comprehensive Stroke Centers (CSCs) found that 58% of CSCs listed BEFAST, while 35% listed FAST. This indicates a growing preference for BEFAST, especially in western and southeastern states. However, the study also highlighted the need for consistent public messaging to improve stroke symptom recognition .
Social Media Campaigns
Innovative public education campaigns, such as the #BEFASTChallenge on social media, have been launched to raise awareness of stroke symptoms. This campaign used dance videos to depict the BEFAST acronym and reached a modest audience with good interaction, demonstrating the potential of social media in public health education.
Conclusion
Both FAST and BEFAST mnemonics are valuable tools for stroke recognition, with BEFAST showing higher specificity and overall diagnostic value in some studies. Public education efforts are increasingly adopting BEFAST, but consistency in messaging remains crucial. Social media campaigns like the #BEFASTChallenge offer promising avenues for increasing public awareness and engagement in stroke symptom recognition.
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