Diagnostic Performance of the BE-FAST-V Scale for Detecting Strokes in the Emergency Department: A Prospective Cohort Study.

Background: Acute stroke, particularly posterior circulation stroke, is often missed in emergency departments due to non-specific symptoms. We aimed to evaluate the diagnostic performance of the BE-FAST-V scale, which adds Vertigo assessment to the original BE-FAST, for acute stroke screening. Methods: The study included 1,094 patients presenting to a tertiary hospital's emergency department with suspected stroke. On arrival, the BE-FAST-V scale, which assesses Balance, Eyes, Face, Arm, Speech, Time, and Vertigo, was administered. Stroke diagnoses were confirmed through imaging. Diagnostic accuracy metrics, including sensitivity, specificity, and predictive values, were calculated. Results: The BE-FAST-V scale demonstrated high diagnostic accuracy, strong sensitivity, and moderate specificity. Adding vertigo improved the detection of posterior circulation strokes, which are often missed due to nonspecific symptoms. Conclusion: The BE-FAST-V tool presented a highly sensitive and practical value for stroke screening in the emergency department. Its ability to identify posterior circulation strokes, including those presenting with vertigo, addresses a critical gap in stroke diagnosis and supports early treatment initiation. Broader implementation and further validation across multiple centers could enhance its role in improving stroke outcomes globally.