A Systematic Review and Meta-Analysis Comparing FAST and BEFAST in Acute Stroke Patients

Abstract

ObjectiveTo evaluate and compare the predictive value of Face, Arm, Speech Test (FAST) and Balance, Eyes, Face, Arm, Speech, Time (BEFAST) scale in the acute ischemic stroke (AIS).MethodsWe searched Medline and Ovid databases for relevant literature in the English language. There were no limitations on the date. The sensitivity, specificity, likelihood ratio, and diagnostic odds ratio were pooled for meta-analysis. The symmetric receiver operator characteristic curve and Fagan's Nomogram were drawn, and meta-regression and subgroup analysis were used to explore the source of heterogeneity.ResultsA total of 9 studies, including 6,151 participants, were analyzed. The combined sensitivity of FAST was 0.77 [95% CI (0.64–0.86)], specificity was 0.60 [95% CI (0.38–0.78)], the area under the ROC curve was 0.76, and the diagnostic ratio was 1.57, while the sensitivity of BEFAST was 0.68 [95% CI (0.23–0.93)], specificity was 0.85 [95% CI (0.72–0.92)], the area under the ROC curve was 0.86, and the diagnostic odds ratio was 2.44. No publication bias was detected in Deeks' funnel plot. For FAST, meta-regression analysis showed that the prospective design, satisfactory description of the index test, and a broad spectrum of disease contributed to the heterogeneity in sensitivity, while no sources contributed to the heterogeneity in sensitivity. When the pretest probability was set as 20%, the posterior probability in Fagan's Nomogram was 32%; however, when the pretest probability was set as 20% in BEFAST, the posterior probability in Fagan's Nomogram was 52%.ConclusionsOur findings indicated that FAST and BEFAST might be useful in the diagnosis of acute ischemic stroke. The diagnostic value of BEFAST in acute ischemic stroke was higher than in FAST; thus, it might have an important role in the fast recognition of acute ischemic stroke.

Time is brain, so we must BEFAST: Improving stroke identification and triage in a rural emergency department

“…1), 9,10,13 and has been reported to significantly improve specificity for stroke detection. 13,14 The majority of studies to date, however, have focused on the ability of BEFAST to correctly identify a stroke, rather than examine a range of other outcomes. 10,13 One previous study noted that results have been limited to prehospital settings, did not include imaging confirmation of stroke or stroke patients without neurological symptoms.…”

“…13,14 The majority of studies to date, however, have focused on the ability of BEFAST to correctly identify a stroke, rather than examine a range of other outcomes. 10,13 One previous study noted that results have been limited to prehospital settings, did not include imaging confirmation of stroke or stroke patients without neurological symptoms. Furthermore, most have focused on evaluating BEFAST only in relation to the detection of acute ischaemic stroke.…”

“…Furthermore, most have focused on evaluating BEFAST only in relation to the detection of acute ischaemic stroke. 13,14 Thus, there is still limited information in the literature validating the tool for general use. 10 The aim of this project was to implement a BEFAST programme in our rural ED, and evaluate any resulting improvements in stroke detection rate at triage, door-to-CT scan time, as well as patient outcomes such as discharge destination and neurological impairment.…”

“…Consequently, there has been emerging use of a modified tool known as BEFAST, Balance, Eyes, Face, Arms, Speech and Time (BEFAST), which adds Balance and Eyes into assessment (Fig. 1), 9,10,13 and has been reported to significantly improve specificity for stroke detection 13,14 . The majority of studies to date, however, have focused on the ability of BEFAST to correctly identify a stroke, rather than examine a range of other outcomes 10,13 .…”

“…One previous study noted that results have been limited to prehospital settings, did not include imaging confirmation of stroke or stroke patients without neurological symptoms. Furthermore, most have focused on evaluating BEFAST only in relation to the detection of acute ischaemic stroke 13,14 . Thus, there is still limited information in the literature validating the tool for general use 10 …”