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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
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.
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.
