There’s New Guidance to Help You Understand Symptoms of Stroke

There’s New Guidance to Help You Understand Symptoms of Stroke
  • The acronym FAST has been used for years to describe symptoms of a stroke.

  • A growing number of organizations are using the BE FAST model instead.

  • Experts say there are pros and cons to this model.

Every 40 seconds, someone in the U.S. has a stroke, making it important to know the signs of this potentially deadly condition. But while the acronym FAST has been used for years to describe symptoms of stroke, one organization has updated its model to be more specific.

The Society of NeuroInterventional Surgery (SNIS) has tweaked the acronym for stroke symptoms to BE FAST and is promoting it as part of the organization’s Get Ahead of Stroke Campaign.

But what is BE FAST and why does it matter? Here’s what experts have to say.

What does BE FAST stand for?

Let’s back up for a moment first. FAST is an acronym endorsed by the American Stroke Association (ASA) and it’s widely recommended by many health organizations and doctors. FAST stands for:

  • Face drooping: Look to see if one side of the face is drooping or numb. You can also ask the person to smile and see if their smile is uneven.

  • Arm weakness: See if one arm is weak or numb. Ask the person to raise both arms and see if one drifts downward.

  • Speech difficulty: See if the person’s speech is slurred.

  • Time to call 911

The ASA also notes that the following can be symptoms of a stroke, but doesn’t include them in the acronym:

  • Numbness or weakness of face, arm, or leg, especially on one side of the body

  • Confusion, trouble speaking, or understanding speech

  • Trouble seeing in one or both eyes

  • Trouble walking, dizziness, loss of balance, or coordination

  • Severe headache with no known cause

BE FAST, on the other hand, stands for the following:

  • Balance difficulties

  • Eyesight changes

  • Facial drooping

  • Arm weakness

  • Speech difficulties

  • Time to call 911

BE FAST isn’t unique to the SNIS—some academic medical centers, including The Ohio State University Wexner Medical Center and Duke Health also use BE FAST. However, it’s not considered the universal acronym for stroke detection.

Why might this change be needed?

There are pros and cons to using this model for stroke detection, says Jason Tarpley, M.D., Ph.D., stroke neurologist and director of the Stroke and Neurovascular Center for Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, Calif.

“If you’re trying to get every single stroke, then it’s important to put in ‘balance’ and ‘eyes’ because, if you’re having a problem in the back of the brain, the FAST acronym is less likely to detect it,” he says. “BE FAST increases the sensitivity of the acronym and enables you to detect more strokes in the back of the brain.”

Strokes in the back of the brain “are very severe strokes,” says Justin A. Singer, M.D., director of neurovascular surgery at Corewell Health in Grand Rapids, Mich., making it especially important to detect them and get treatment ASAP. “While these symptoms are less common, including them in the acronym could help people better understand what is happening and seek medical attention sooner,” he adds.

This model “will lead to better stroke detection overall,” says Deepak Gulati, M.D., a neurologist at The Ohio State University Wexner Medical Center, noting that his medical center has been advocating for the use of BE FAST in their screening tools for years.

But using BE FAST can also raise the risk of false alarms, Dr. Tarpley says. “A lot of times, problems with balance and eyes is not a stroke,” he says. “If you use BE FAST, you’re going to devote a lot of resources to testing people, thinking that they have strokes, who did not have a stroke.”

However, Dr. Tarpley says the risk of false positives is “something we need to accept.”

“We have really powerful treatments for stroke—they are highly effective and beneficial, but they’re also highly time-dependent,” he says. “That’s why it’s worth accepting some false positives.”

Dr. Singer agrees. “Many of the treatments we offer, such as clot-busting medication or mechanical thrombectomy to retrieve the clot, are time sensitive,” he explains. “The sooner we can intervene, the better opportunity there is to reduce the size of the stroke and help our patients recover and maintain functional independence.”

“I think this is something that will be adopted by more organizations,” says Robert Eisenstein, M.D., associate professor and chair of the Department of Emergency Medicine at Rutgers Robert Wood Johnson Medical School. “Stroke is a very time sensitive situation. Sometimes when people arrive at hospitals, it’s not recognized right away. Adding balance and eye changes can help.”

What to do if you suspect someone is having a stroke

Next moves are simple, Dr. Tarpley says: Call 911. “Don’t bring your loved one to the hospital,” he says. “Don’t put them in the car and take them. 911 has a mechanism to communicate early on with the hospital to let them know that they’re bringing you in.”

If you walk in to the emergency room, you and your loved one will likely have to wait to be seen—and that’s an issue with stroke treatment. “A fast response is crucial,” Dr. Tarpley says.

Dr. Gulati agrees. “‘Time is brain’ as we tend to lose 2 million brain cells per minute during stroke,” he says. “Call 911 immediately.”

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