ABSTRACT NUMBER: ESOC2026A1150 A SINGLE-CENTRE RETROSPECTIVE AUDIT OF FINAL CLINICAL DIAGNOSES IN PATIENTS TRIGERRED AS FAST POSITIVE IN A DUBLIN TEACHING HOSPITAL

Abstract Background and aims The FAST assessment is used to enable the rapid identification of patients with suspected stroke. Reviewing the final diagnosis of FAST activations allows assessment of diagnostic accuracy & informs resource utilisation. To analyse the final clinical diagnoses of patients triggered as FAST positive over a 10-month period in a Dublin teaching hospital, focusing on the distribution of confirmed stroke & common stroke mimics. Methods A single centre retrospective audit was conducted on all consecutive FAST calls between January 2025 and October 2025 in a regional thrombolysis centre. Final diagnoses were categorised into: Stroke, TIA, Migraine, Bell’s palsy, Vertigo, Seizure, Syncope, Subdural Haematoma (SDH), Cerebral Amyloid Angiopathy (CAA), and Other. Results Among 641 FAST positive presentations over a 10-month period, Stroke was the most common diagnosis accounting for 41% (263/641) of cases, while other diagnoses including TIA (4%) migraines (7%), Bell’s palsy (4%), seizures (6%), syncope (3%), and vertigo (3% ) were less commonly observed. Subdural hematomas and cerebral amyloid angiopathy were rare (<1%). A large proportion of patients (32%) had other diagnoses reflecting a variety of alternative diagnoses beyond those classically associated with FAST symptoms. Conclusions The FAST assessment identified a high proportion of patients with a final diagnosis of acute stroke/TIA. Nevertheless a majority of patients presenting as FAST positive were stroke mimics related to other neurological, systemic conditions & other miscellaneous causes. Findings highlight that while the FAST assessment is effective for rapid recognition, a significant proportion of FAST positive patients will be stroke mimics which has implications for resource utilisation. Conflict of interest Nothing to disclose