Recognition and Early Assessment of Acute Stroke Using the FAST and BE FAST Approach-An Updated Review.

Background: Acute stroke requires rapid recognition and referral to improve access to time-dependent treatments and reduce mortality and long-term disability. Delays in symptom identification, emergency response, and hospital referral remain major challenges across healthcare systems. Aim: This systematic review aimed to evaluate the effectiveness of stroke recognition tools and referral strategies in primary and emergency care and examine their effects on treatment timeliness and patient outcomes. Methods: A systematic review was conducted of 33 studies published between 2003 and 2025. The included studies investigated conventional stroke recognition scales, dispatcher-based triage systems, emergency medical services interventions, mobile stroke units, and artificial intelligence-based approaches. Evidence was synthesized narratively because of heterogeneity in study designs, populations, diagnostic accuracy measures, and reported outcomes. Results: FAST, CPSS, ROSIER, and NIHSS were frequently evaluated, with conventional screening tools generally demonstrating sensitivity above 80%, although specificity varied. PreHAST and FAST-ED showed potential for identifying severe stroke and large vessel occlusion. Dispatcher-based systems improved emergency prioritization and reduced referral delays by approximately 12–20 minutes. Mobile stroke units reduced time to imaging by 8–17 minutes and increased reperfusion eligibility by 7–12%. Improved recognition and referral were associated with greater treatment access and functional independence. However, rural and resource-limited settings continued to experience delays related to transportation, imaging availability, and EMS capacity. AI-based approaches showed promising diagnostic performance but require further validation. Conclusion: Structured recognition tools and coordinated referral pathways improve early stroke management. Their effectiveness depends on appropriate implementation, healthcare infrastructure, and equitable access to emergency services.