BE-FAST vs FAST in prehospital stroke recognition: a systematic review

Detecting acute ischaemic stroke in its early stages is critical for improving the patient's chances of a favorable outcome. While face, arm, speech, time (FAST) is the generally accepted tool for the prehospital screening of suspected stroke patients, it is proposed that the more extensive balance, eyes, face, arm, speech, time (BE-FAST) may improve stroke recognition. This systematic review compares the efficacy of FAST and BE-FAST in detecting acute stroke in prehospital settings. A systematic literature search was conducted across four databases including MEDLINE, ProQuest, CINAHL and PubMed. Included articles compared diagnostic performance of FAST and BE-FAST for ischaemic stroke recognition in the ambulance, or when used by emergency medical services. Only original research published in the English language was included. Sensitivities of FAST ranged from 64% to 97%, while specificities ranged from 13% to 76.9%, showing a wide variation across the studies. The only study that considered BE-FAST reported its sensitivity and specificity as 91% and 53%, respectively, compared to 76% and 68%, respectively, for FAST. There is limited data on the performance of BE-FAST in the prehospital setting. The findings of this systematic review suggest that both FAST and BE-FAST perform reasonably for prehospital stroke recognition, although specificity of these scales is generally low. BE-FAST may be more sensitive to detect stroke, but there is insufficient evidence to draw a conclusion.