FAST
The key element of stroke assessment is stroke recognition. This includes encouraging the public to react to stroke symptoms and call 999.
A useful tool for pre-hospital assessment of suspected acute stroke is FAST: Face – Arm – Speech – Test.
There are public awareness campaigns using FAST (‘Stroke – Act FAST’), and patients at high risk of stroke should be given information about calling for immediate help at the onset of symptoms.
This is an important aspect of TIA management in the ED if the patient is to be managed as an outpatient.
FAST
Score 1 point for each feature:
- Face weakness
- Arm weakness
- Speech disturbance
Maximum score 3, Minimum score 0. ‘T’ refers to time, highlighting the urgency of seeking medical attention if a score of ³1 is reached.
FAST is used by the ambulance services, and this is now a component of paramedic training and documentation in the UK. It is also part of the pre-alert information given to the hospital prior to the patient’s arrival.
It has been shown to have a 78% (95% CI 72-84%) positive predictive value (PPV) and a 73% (CI 66-80%) negative predictive value (NPV) for paramedics recognising stroke [3].
Amongst members of the public, the FAST campaign has raised awareness of stroke warning signs (awareness of facial weakness at 89%, arm weakness at 83%, and speech problems at 91%), though leg weakness and visual loss were not well recognised (57% and 44% awareness respectively) [4]. Bystander response to a witnessed stroke was seen to improve in one study as a result of this campaign [5], though other studies have disagreed on its lasting effectiveness [6].