Fast for stroke test
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FAST for Stroke Test: A Comprehensive Review
Introduction to FAST and BEFAST Stroke Tests
The Face, Arm, Speech Test (FAST) and the Balance, Eyes, Face, Arm, Speech, Time (BEFAST) scale are widely used tools for the rapid identification of acute ischemic stroke (AIS). These tools are designed to help both medical professionals and the general public quickly recognize the signs of a stroke and seek immediate medical attention.
Effectiveness of FAST and BEFAST in Acute Stroke Diagnosis
Sensitivity and Specificity
A systematic review and meta-analysis comparing FAST and BEFAST in acute stroke patients revealed that FAST has a sensitivity of 0.77 and a specificity of 0.60, while BEFAST has a sensitivity of 0.68 and a specificity of 0.85. The area under the ROC curve for FAST was 0.76, compared to 0.86 for BEFAST, indicating that BEFAST has a higher diagnostic value for acute ischemic stroke.
Predictive Value in Prehospital Settings
In the prehospital setting, both FAST and the Recognition of Stroke in the Emergency Room (ROSIER) tool have shown similar sensitivities for stroke recognition. However, ROSIER demonstrated a higher specificity, suggesting it may be more accurate in certain scenarios. Additionally, the BEFAST tool has been validated as a sensitive screening tool for in-hospital acute ischemic stroke, showing a sensitivity of 85% for inpatients and 94% for community-onset stroke alerts.
Advanced Stroke Scales for Large Vessel Occlusion (LVO)
mG-FAST and FAST-ED
The modified Gaze-Face-Arm-Speech-Time (mG-FAST) scale has been developed to identify both large vessel occlusion (LVO) and non-LVO strokes in the prehospital setting. This scale demonstrated a sensitivity of 0.97 and specificity of 0.55 for LVO, significantly improving EMS dispatch-to-treatment times. Similarly, the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale, which includes additional items from the NIHSS, has shown high accuracy in predicting LVO, with an area under the ROC curve of 0.81 .
Comparison of Prehospital Stroke Scales
A study comparing eight prehospital stroke scales, including RACE, LAMS, and CPSS, found that the RACE scale had the highest area under the ROC curve (0.83) for detecting anterior circulation LVO, followed closely by G-FAST and CG-FAST. These findings suggest that while FAST and BEFAST are effective for general stroke identification, specialized scales like mG-FAST and FAST-ED are more suitable for identifying LVO strokes.
Limitations of FAST in Detecting Posterior Circulation Stroke (PCS)
Posterior circulation stroke (PCS) accounts for up to 25% of ischemic strokes and often presents with symptoms not covered by the FAST criteria, such as vestibular symptoms. This limitation can lead to misdiagnosis and treatment delays. Therefore, additional neurological assessments alongside FAST are recommended to improve the detection of PCS in the prehospital setting.
Conclusion
Both FAST and BEFAST are valuable tools for the rapid identification of acute ischemic stroke, with BEFAST showing a higher diagnostic value. For the detection of large vessel occlusion strokes, advanced scales like mG-FAST and FAST-ED offer improved accuracy and efficiency. However, the limitations of FAST in detecting posterior circulation strokes highlight the need for supplementary neurological assessments to ensure comprehensive stroke diagnosis.
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