FAST (stroke)

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FAST is an acronym used as a mnemonic to help detect and enhance responsiveness to the needs of a person having a stroke. The acronym stands for Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services.[1]

  • Facial drooping: A section of the face, usually only on one side, that is drooping and hard to move. This can be recognized by a crooked smile.
  • Arm weakness: The inability to raise one's arm fully, or the inability to hold something or squeeze i.e. someone's hand.
  • Speech difficulties: An inability or difficulty to understand or produce speech, slurred speech or having difficulty repeating even a basic sentence such as "The sky is blue".
  • Time: If any of the symptoms above are showing, time is of the essence; call the emergency services and go to the hospital immediately.[1] It is also important to check the time so that you'll know when the first symptoms appeared (time is brain[2])

History[edit]

The FAST acronym was developed in the UK in 1998 by a group of stroke physicians, ambulance personnel, and an emergency department physician and was designed to be an integral part of a training package for ambulance staff. The acronym was created to expedite administration of intravenous tissue plasminogen activator to patients within 3 hours of acute stroke symptom onset. The instruments at this time with most evidence of validity were the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS).[3]

Studies using FAST have demonstrated variable diagnostic accuracy of strokes by paramedics and emergency medical technicians with positive predictive values between 64% and 77%.[4]

Other acronyms such as BE-FAST has shown promise by capturing >95% of ischemic strokes,[5] however adding coordination and diplopia assessment did not improve stroke detection in the prehospital setting.[6]

Alternative versions[edit]

BE-FAST has shown promise and is currently being studied as an alternative method to the FAST acronym.[5]

  • Balance
  • Eyes
  • Face
  • Arm
  • Speech
  • Time

References[edit]

  1. ^ a b "Stroke Warning Signs and Symptoms". www.strokeassociation.org. Retrieved 2017-01-03.
  2. ^ Saver Jeffrey L. (2006-01-01). "Time Is Brain—Quantified". Stroke. 37 (1): 263–266. doi:10.1161/01.STR.0000196957.55928.ab. PMID 16339467.
  3. ^ Harbison, Joseph; Hossain, Omar; Jenkinson, Damian; Davis, John; Louw, Stephen J.; Ford, Gary A. (January 1, 2003). "Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test". Stroke. 34 (1): 71–76. doi:10.1161/01.STR.0000044170.46643.5E. PMID 12511753.
  4. ^ Harbison Joseph; Hossain Omar; Jenkinson Damian; Davis John; Louw Stephen J.; Ford Gary A. (2003-01-01). "Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test". Stroke. 34 (1): 71–76. doi:10.1161/01.STR.0000044170.46643.5E. PMID 12511753.
  5. ^ a b Aroor Sushanth; Singh Rajpreet; Goldstein Larry B. (2017-02-01). "BE-FAST (Balance, Eyes, Face, Arm, Speech, Time)". Stroke. 48 (2): 479–481. doi:10.1161/STROKEAHA.116.015169. PMID 28082668.
  6. ^ Pickham, David; Valdez, André; Demeestere, Jelle; Lemmens, Robin; Diaz, Linda; Hopper, Sherril; de la Cuesta, Karen; Rackover, Fannie; Miller, Kenneth; Lansberg, Maarten G. (March 2019). "Prognostic Value of BEFAST vs. FAST to Identify Stroke in a Prehospital Setting". Prehospital Emergency Care. 23 (2): 195–200. doi:10.1080/10903127.2018.1490837. ISSN 1545-0066. PMID 30118372.