ISC 2025 | A comparison of FAST and BE-FAST performance in stroke detection by the general public

I guess I’ll start with the notion of stroke being a medical emergency. And so for patients who are having a stroke or we suspect of having a stroke, the quicker we get them to the emergency department, the better the chances are of making sure that we prevent the consequences of the stroke. So along those lines, the FAST acronym for the Face, Arms, Speech, and Time acronym, so it’s developed as a means of making sure that if somebody suspects a stroke by virtue of there being a facial droop, arm weakness, or a speech difficulty, that that person knows it’s time to call 911 or emergency medical services to try and get the person suffering a stroke to the emergency department. We’ve known for a long time that FAST captures about 80 percent of all strokes, And so in particular, it tends to miss the posterior circulation of stroke that is affecting the back of the brain. So BE-FAST, that adds balance and a change in the patient’s eyes to the FAST acronym, was developed to try and capture that 20% of strokes that FAST misses. So a lot of hospital systems and a lot of public awareness campaigns have adopted BE-FAST mainly for the ability to capture all types of strokes. What is not known is whether for the general public, the addition of those two more variables, whether or not that actually impacts the ability of the non-medical provider to retain and remember the signs and symptoms of stroke. So that was the basis for the study, but for us to compare these two acronyms in a general public population to see what impact it has on their recollection of face, arm, and speech, which is by far the dependence of all the strokes. And then secondly, whether or not it impacts their intention to call 911 or emergency medical services to get the person they suspect of having a stroke to the emergency department. What we did was we created these one-minute educational videos for one for FAST and one for BE-FAST. The videos look very similar, except, of course, the one added balance and eyes to the FAST feature. And so we surveyed 1,900 people in the general public who participated, and they were then randomized to either the BE-FAST or the FAST educational video. And immediately after the educational video, at baseline, before the video, we checked our understanding and awareness of FAST and BE-FAST and their willingness to call 911 if somebody was suspected of having a stroke. Immediately after the video then, we checked understanding again of FAST and BE-FAST and willingness to call 911. And then we surveyed the group again 30 days later. And at 30 days, we had about 1,400 people that were originally surveyed that then followed up at 30 days. So about a 70% retention rate. And what we found was at baseline, about a third in both groups knew face, arm, and speech before the educational intervention. With the educational intervention, that increased to about 70% in the FAST group and about 50% in the BE-FAST group. So immediately we see that there’s a difference in the general public ability to retain and remember face, arm, and speech as signs and symptoms of stroke. There was no difference in the intention to call 911. So at baseline there was about 80 percent intention to call 911 if somebody was suspected of having a stroke. That increased immediately after the educational intervention. When we went out to 30 days, the gap between the FAST and the BE-FAST group remained. Both groups had sort of lost a little bit of recollection. But the FAST group retained more than the BE-FAST group at 30 days. And similarly, with regards to calling 911, there was no difference between the groups in intent to call 911. There was a slight drop off at 30 days, but both groups were comparable in terms of the intentions to call 911. So we concluded that basically the addition of balance and eyes to FAST, again, within a general public population, really does seem to impact the ability of the general public to retain knowledge of the face, arm, and speech, likely due to the cognitive load of those additional couple of factors. I keep saying general public because I think it’s important to make a distinction between public service and public awareness campaign versus our clinical practice. And so many hospital organizations confound those two things, whereby for the general public, if we start promoting BE-FAST, I think the consequence may be that the public awareness of signs and symptoms of stroke may be reduced. Whereas if we were talking about what our paramedics or EMS calling and as what we as clinicians should be using as a fast, as a quick screening tool for stroke? That’s a different question. And so this specifically speaks to the general public and the ability of the general public to retain six items versus four items in terms of stroke awareness and stroke recognition. So I think in terms of public awareness campaign, FAST seems to be the better approach. Whereas if we were talking about emergency medical services providers or other healthcare professionals, we didn’t address this question, but it may be perfectly legitimate to use BE-FAST in that context while we’re aware that for the general public FAST seems to be the better option.

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