To FAST or not to FAST?

UPESI: Swahili translation of the FAST acronym for stroke awareness campaigns in East Africa

Introduction

Despite stroke being a leading cause of death and disability in sub-Saharan Africa, stroke awareness remains a major hurdle to early stroke response and care in the region. To improve stroke awareness, we endeavoured to borrow a leaf from initiatives in high-income countries, beginning with the translation and dissemination of the acronym, FAST (Face, Arms, Speech, Time) to Swahili.

Methods

We formed a translation group consisting of two stroke physicians, one nurse and two professional translators, all native Swahili speakers. Forward translation of the original document from English to Swahili was done by one Swahili translator; followed by a backward translation by another translator. Clinician reviews and cognitive reviews were then done, and a final translation was developed.

Results

We developed the acronym UPESI, a Swahili translation of the word, FAST. The acronym stands for U so kupooza upande mmoja; P ooza mkono/mguu (au kupoteza hisia); ugumu ku- E leza/kuongea; SI mu upesi translating to face drooping, arm/leg paralysis, difficulty in speaking/explaining and fast to the phone.

Conclusion

The result of this process is a Swahili translation of the FAST tool for stroke awareness campaigns. The translation will improve communication during stroke campaigns and increase awareness of stroke.

Stroke 112: A Universal Stroke Awareness Program to Reduce Language and Response Barriers

BACKGROUND AND PURPOSE

To improve stroke awareness and reduce life-threatening prehospital delays worldwide, a universal stroke educational program is needed. To meet this unmet need, we developed a universal program without language barriers and tested its acceptance in Taiwan, where Chinese is the native language.

METHODS

Stroke 112 was developed using the universal emergency phone number, 112. The numbers imply an emergency and correspond to the 3 stroke recognition signs used in FAST (Face, Arm, Speech, and Time): 1 uneven face (crooked mouth); 1 weak arm (arm weakness); 2 incoherent lips (slurred speech). An online survey was used to determine the acceptance of the Stroke 112 program compared with that of FAST in Chinese. The surveys were delivered using SurveyMonkey (http://www.surveymonkey.com) on 2 separate occasions in Taiwan; in August 2017 for an initial estimation of the acceptance of Stroke 112 and in March 2018, 2 weeks after the official release of Stroke 112 in Taiwan, including a special introductory lecture for neurologists hosted by the STARS-Taiwan (Stroke Treatment and Research Society-Taiwan).

RESULTS

The initial survey with 465 survey responders, 54.6% thought that Stroke 112 was easier to remember for people in Taiwan compared with FAST (41.2%). After Stroke 112's official release in Taiwan, 610 individuals completed the survey, and the majority (66.4%) thought that Stroke 112 was easier to remember, a significant increase compared with the initial survey (P=0.0001). Among the 130 neurologists who attended the Stroke 112 introductory lecture, 55 completed the online survey. A greater acceptance of Stroke 112 (74.6%) compared with FAST (16.4%) was observed among these 55 neurologists (P=0.0001).

CONCLUSIONS

Stroke 112, a universal stroke educational program without language barriers was developed. It could potentially be implemented worldwide, especially where 112 is used as an emergency phone number.

Patients' responses to transient ischaemic attack symptoms: a cross-sectional questionnaire study in Australian general practices

BACKGROUND

Consensus guidelines for transient ischaemic attack (TIA) recommend urgent investigation and management, but delays in management occur and are attributable to patient and health system factors.

AIM

To establish general practice patients' anticipated responses to TIA symptoms, and associations of appropriate responses.

DESIGN AND SETTING

A cross-sectional questionnaire-based study in Australian general practices.

METHOD

Consecutive patients attending general practices completed questionnaires that contained the Stroke Action Test (STAT) adapted for TIA about demographic, health system use, and stroke risk factors. STAT elicits appropriate or inappropriate anticipated responses to 28 symptom complexes. Anticipated actions in-hours and out-of-hours were elicited. Associations of independent variables with adapted-STAT scores were tested with multiple linear regression.

RESULTS

There were 854 participants (response rate 76.9%). Urgent healthcare-seeking responses to transient neurological symptoms ranged from 96.8% for right-sided weakness with dysphasia to 59.1% for sudden dizziness. Associations of higher adapted-STAT scores were older age, Indigenous status, previous after-hours services use, self-perception of health as poor, and familiarity with a stroke public awareness campaign. A personal or family history of stroke, smoking status, and time of event (in-hours/out-of-hours) were not significantly associated with adapted-STAT scores.

CONCLUSION

Most general practice attendees expressed intentions to seek health care urgently for most symptoms suggestive of TIA, with highest levels of urgency observed in high stroke-risk scenarios. Intentions were not associated with a number of major risk factors for TIA and might be improved by further educational interventions, either targeted or at population level.

Clinical signs in young patients with stroke related to FAST: results of the sifap1 study

OBJECTIVES

The present study aimed to evaluate the frequency of warning signs in younger patients with stroke with a special regard to the 'FAST' scheme, a public stroke recognition instrument (face, arm, speech, timely).

SETTING

Primary stroke care in participating centres of a multinational European prospective cross-sectional study (Stroke in Young Fabry Patients; sifap1). Forty-seven centres from 15 European countries participate in sifap1.

PARTICIPANTS

5023 acute patients with stroke (aged 18-55 years) patients (96.5% Caucasians) were enrolled in the study between April 2007 and January 2010.

PRIMARY AND SECONDARY OUTCOME MEASURES

sifap1 was originally designed to investigate the relation of juvenile stroke and Fabry disease. A secondary aim of sifap1 was to investigate stroke patterns in this specific group of patients. The present investigation is a secondary analysis addressing stroke presenting symptoms with a special regard to signs included in the FAST scheme.

RESULTS

4535 patients with transient ischaemic attack (TIA; n=1071), ischaemic stroke (n=3396) or other (n=68) were considered in the presented analysis. FAST symptoms could be traced in 76.5% of all cases. 35% of those with at least one FAST symptom had all three symptoms. At least one FAST symptom could be recognised in 69.1% of 18-24 years-old patients, in 74% of those aged 25-34 years, in 75.4% of those aged 35-44 years, and 77.8% in 45-55 years-old patients. With increasing stroke severity signs included in the FAST scheme were more prevalent (National Institute of Health Stroke Scale, NIHSS<5: 69%, NIHSS 6-15: 98.9%, NIHSS>15: 100%). Clustering clinical signs according to FAST lower percentages of strokes in the posterior circulation (65.2%) and in patients with TIA (62.3%) were identified.

CONCLUSIONS

FAST may be applied as a useful and rapid tool to identify stroke symptoms in young individuals aged 18-55 years. Especially in patients eligible for thrombolysis FAST might address the majority of individuals.

STUDY REGISTRATION

The study was registered in http://www.clinicaltrials.gov (No. NCT00414583).

Stroke awareness among low literacy Latinos living in the South Carolina low country

BACKGROUND

Little is known about stroke awareness in Latinos with low literacy and living in regions with high stroke rates.

METHODS

We surveyed a convenience sample of 60 adult Latinos living in Charleston South Carolina to examine recognition of 4 common warning signs of stroke and appropriate first action to call 9-1-1.

RESULTS

Forty-six percent of the participants recognized sudden facial, arm, or leg weakness; 39% recognized sudden vision loss; 43% recognized sudden trouble walking; 45% recognized sudden headache; 17% recognized all four warning signs. Twenty-seven percent of the participants incorrectly identified chest pain as a warning sign of stroke. Participants at the lowest literacy levels recognized three of the four warning signs more frequently than the participants at higher literacy levels.

DISCUSSION

Overall, awareness of stroke warning signs was considerably low in this high-risk population. The relationship between low-literacy and stroke awareness was unclear in this sample.