Diagnostic Accuracy of the ACT-FAST Tool for Prehospital Stroke Identification: A Systematic Review

Stroke is the second leading cause of death globally, resulting in 5.5 million deaths annually. The ACT-FAST is a simplified, rapid assessment tool aimed at improving the early detection of stroke and may outperform existing tools in identifying large vessel occlusions (LVOs). We aimed to assess the diagnostic accuracy of this tool in this systematic review.

In this systematic review, we conducted a comprehensive search of Medline, Scopus, Web of Science, and Embase. Studies with incomplete data reporting or those focusing on other triage tools were excluded. Two independent reviewers screened titles, abstracts, and full texts, and extracted relevant data using a pre-designed checklist.

Our systematic review identified four studies on the ACT-FAST tool, all conducted primarily in Australia with a predominantly elderly patient population. Reported findings indicate that ACT-FAST has demonstrated generally high diagnostic performance, with retrospective analyses showing accuracies above 90%. Sensitivity varied across study designs, ranging from 63% to 100%, while specificity was consistently reported above 85%. Despite concerns regarding potential bias from non-random patient selection and incomplete reporting of symptom onset, the overall methodological quality was robust.

The ACT-FAST algorithm demonstrates generally high, though variable, sensitivity and consistently high specificity, supporting its utility as a valuable tool for paramedics and clinicians in prehospital stroke management and for effectively identifying patients with LVO. This capability facilitates timely intervention, minimizes unnecessary transfers for patients without LVO, and optimizes resource allocation, ultimately improving patient outcomes in stroke care.