Stroke recognition mnemonics
Pro Research Analysisby 
Searched over 200M research papers
Stroke Recognition Mnemonics: FAST, BEFAST, and Language-Specific Tools
FAST and BEFAST Mnemonics for Stroke Symptom Recognition
The most widely used mnemonics for recognizing stroke symptoms are FAST (Face, Arm, Speech, Time) and BEFAST (Balance, Eyes, Face, Arm, Speech, Time). FAST is endorsed by major organizations but can miss up to 14% of strokes, particularly those involving the posterior circulation, which often present with balance and vision problems not covered by FAST. BEFAST addresses this gap by adding Balance and Eyes to the mnemonic, improving the detection of these types of strokes 12369.
Effectiveness and Adoption of FAST and BEFAST
Studies show that BEFAST is more sensitive than FAST in identifying posterior circulation strokes, with BEFAST detecting 97.8% of such cases compared to 58.7% for FAST. However, BEFAST has a lower specificity, meaning it may result in more false positives. Notably, using only FAST would miss nearly 40% of posterior strokes 69.
Despite BEFAST’s improved sensitivity, public education materials in the US show inconsistent use: 58% of comprehensive stroke centers list BEFAST, while 35% use FAST, and 7% use no mnemonic at all. This inconsistency highlights the need for unified public messaging to improve stroke recognition 123.
Retention and Recall of Stroke Mnemonics
A randomized trial comparing the retention of FAST and BEFAST found that people remembered FAST better, both immediately and after 30 days. Adding Balance and Eyes to the mnemonic (BEFAST) actually reduced the ability to recall the more common symptoms (face, arm, speech) over time. This suggests that while BEFAST may help identify more strokes, especially those with less typical symptoms, it may be harder for the public to remember all the components .
Mnemonics in Other Languages: AHORA and RAPIDO
For Spanish-speaking populations, mnemonics like AHORA and RAPIDO are used. Research shows that AHORA, which is shorter and emphasizes calling emergency services, is preferred over RAPIDO for its clarity and conciseness. Participants found AHORA easier to understand and more effective for communicating stroke signs, especially in populations with cognitive impairment 58.
Pediatric Stroke Recognition
In children, the FAST mnemonic is less sensitive, especially for those under three years old. Adding new onset seizures to the mnemonic (creating FAST-S) increases sensitivity, particularly in very young children, suggesting that stroke recognition tools may need to be adapted for pediatric populations .
Improving Inpatient Stroke Recognition
Implementing BEFAST in hospital protocols, especially for nursing staff, improves stroke knowledge, documentation, and response times. Education and clear protocols using BEFAST help nurses recognize and act on stroke symptoms more effectively, which is crucial for patient outcomes .
Conclusion
FAST and BEFAST are the primary mnemonics for stroke recognition, with BEFAST offering improved sensitivity for posterior strokes but at the cost of lower recall and specificity. Consistent public education and adaptation of mnemonics for different languages and populations, including children, are essential for improving stroke recognition and outcomes. Unified messaging and tailored tools can help ensure that more strokes are recognized quickly, leading to faster treatment and better recovery.
Sources and full results
Most relevant research papers on this topic