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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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BE-FAST vs FAST in prehospital stroke recognition: a systematic review.

Matthew Hilditch1,2, Charles Brand3, Shane Devlin3

  • 1University of Stavanger, Faculty of Health Sciences, Stavanger, Norway.

British Journal of Community Nursing
|August 27, 2025
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Summary

The Balance, Eyes, Face, Arm, Speech, Time (BE-FAST) scale may improve acute ischemic stroke detection compared to the Face, Arm, Speech, Time (FAST) tool in prehospital settings, though more research is needed.

Keywords:
BE-FASTFASTacute strokeambulanceemergency medical servicesprehospitalstroke

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Diagnostic Tools

Background:

  • Early detection of acute ischemic stroke is crucial for patient outcomes.
  • The Face, Arm, Speech, Time (FAST) tool is standard for prehospital stroke screening.
  • The Balance, Eyes, Face, Arm, Speech, Time (BE-FAST) scale is a proposed enhancement to FAST.

Purpose of the Study:

  • To systematically review and compare the diagnostic efficacy of FAST and BE-FAST in prehospital acute stroke detection.

Main Methods:

  • A systematic literature search was performed across MEDLINE, ProQuest, CINAHL, and PubMed.
  • Included studies compared the diagnostic performance of FAST and BE-FAST for ischemic stroke recognition by emergency medical services.
  • Original research published in English was included.

Main Results:

  • FAST sensitivity ranged from 64% to 97%, with specificity from 13% to 76.9%.
  • The single study evaluating BE-FAST reported 91% sensitivity and 53% specificity, versus 76% sensitivity and 68% specificity for FAST.

Conclusions:

  • Limited data exists on BE-FAST's prehospital performance.
  • Both FAST and BE-FAST show reasonable performance for prehospital stroke recognition, but with generally low specificity.
  • BE-FAST may offer higher sensitivity for stroke detection, but evidence remains insufficient.