Published: 2022-03-25

The stroke detections scales for emergency response workers: a comparison of FAST versus BEFAST

Nantawan Tippayanate, Phatcharee Phonkanya, Kanokwan Nuangkantee, Kamonchanok Nuangkantee, Rungthiwa Wijanjit, Ajchra Khamya, Kiattisak Chaiprom, Juntana Sriprow, Chattarin Sripol, Maitree Tornsao


Background: Eighty percent of strokes are ischemic, resulting from cerebral artery blockages. However, due to delays in taking patients to hospital, only around 3% of patients receive suitable treatment in time.

Methods: This research assessed the accuracy of diagnostic tests. Registry data concerning stroke patients were analyzed to compare the diagnoses made during the dispatching of suspected stroke patients with the final diagnoses made by hospital emergency departments in order to evaluate the validity of the initial tests.

Results: The study investigated a sample group of 317 patients. Over fifty percent lived in rural locations. The stroke patients tended to be of more advanced age, and presented significantly more underlying conditions than non-stroke patients (p<0.05). The data were collected over a period of one year, and the scale used was predominantly the BEFAST. Between stroke and non-stroke patients, significant differences were found only in terms of facial drooping and weakened arms (p<0.05). The accuracy levels of the BEFAST and FAST scales could be considered similar when comparing the area under the curve. BEFAST had AUC of 0.551 while for FAST the value was 0.706 (p=0.059).

Conclusions: It is possible to increase the sensitivity of BEFAST by including testing for coordination and diplopia, but the results in lowered PPV and specificity. Given that additional time is necessary in order to test coordination and diplopia, it would appear unlikely that this delay during dispatch will be beneficial even when improved sensitivity is taken into account.


Stroke detection scale comparison, EMD, BEFAST scale, FAST scale, Diagnostic testing

Full Text:



Feigin VL, Roth GA, Naghavi M. Global burden of stroke. Stroke. 2016;10:165-206.

Cassella CR, Jagoda A. Ischemic stroke. Emergency Medicine Clinics of North America. 2017;35(4):911-30.

Kamal N, Benavente O, Boyle K, Buck B, Butcher K, Casaubon LK et al. Good is not good enough: the benchmark stroke door-to-needle time should be 30 56 minutes. Canadian Journal of Neurological Sciences. 2014;41(6):694-6.

Cadilhac DA, Purvis T, Kilkenny MF, Longworth M, Mohr K, Pollack M, et al. Evaluation of rural stroke services: Does implementation of coordinators and pathways improve care in rural hospitals? Stroke. 2013;44:2848-53.

Lin CB, Peterson ED, Smith EE, Saver JL, Liang L, Xian Y et al. Patterns, predictors, variations, and temporal trends in emergency medical service hospital prenotification for acute ischemic stroke. Journal of the American Heart Association. 2012;1(4):1-16.

Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2007;CD000197.

Saver J. Time is brain-Quantified. Stroke. 2006;37:263-6.

Geisler F, Ali SF, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, et al. Evaluation of a score for the prehospital distinction between cerebrovascular disease and stroke mimic patients. Int J Stroke. 2018:1-9.

MacFarlane C. The advances and evidence base for prehospital care. Emergency Medicine Journal. 2003;20(2):114-5.

Brandler ES, Sharma M, Sinert RH, Levine SR. Prehospital stroke scales in urban environments: A systematic review. Neurology. 2014;82(24) 2241-49.

Berglund A, Svensson, Wahlgren N, von Euler M. Face Arm Speech Time Test use in the prehospital setting better in the ambulance than the emergency medical communication center. Cerebrovascular Dis. 2014;37(3):212-6.

Pickham D, Valdez A, Demeestere J, Lemmens R, Diaz L, Hopper S et al. Prognostic value of BEFAST vs. FAST to identify stroke in a prehospital setting. Prehospital Emergency Care. 2018;1-7.

Lawlor M, Perry R, Plant GT. Is the 'Act FAST' stroke campaign lobeist? The implications of including symptoms of occipital lobe and eye stroke in public education 57 campaigns. Journal of neurology, neurosurgery and psychiatry. 2015;86(7):818-20.

Caceres J, Adil M, Jadhav V, Chaudhry S, Pawar S, Rodriguez G et al. Diagnosis of stroke by emergency medical dispatchers and its impact on the prehospital care of patients. Journal of Stroke and Cerebrovascular Diseases. 2013;22(8):e610-4.

Faten El Ammar, Ardelt A, Brutto VJDL, Loggini A, Bulwa Z, Martinez RC et al. Goldenberg. BE-FAST: A Sensitive Screening Tool to Identify In-Hospital Acute Ischemic Stroke. J of Stroke and Cerebrovascular Disease. 2020;29(7):1-7.

Glober N, Sporer K, Guluma K, Serra J, Barger J, Brown J et al. Acute stroke: current evidence-based recommendations for prehospital care. West J Emerg Med. 2016;17(2):104-28.

Fothergill RT, Williams J, Edwards MJ, Russell IT, Gompertz P. Does use of the recognition of stroke in emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians? Stroke. 2013;44(11):3007-12.

Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischemic stroke: a meta-analysis of individual patient data from five randomisedtrials. Lancet. 2016;387(10029):1723-31.