Stroke Assessment Calculator

Multi-scale stroke screening tool featuring FAST, BEFAST, Cincinnati, and NIHSS assessments. Critical for time-sensitive neurological emergencies requiring immediate recognition and transport.

Stroke Assessment

Time-critical neurological emergency screening - Multiple validated scales

Select Assessment Scale:

Time Required: Assessment takes 1-2 minutes

Symptom Onset Time:

Critical for treatment decisions - use last known normal if unsure

Current Time: 23:39

F - Face

Instructions: Ask patient to smile or show teeth. Look for facial asymmetry.

Normal

Both sides of face move equally

Facial Droop ABNORMAL

One side of face droops or is numb

A - Arms

Instructions: Ask patient to raise both arms for 10 seconds. Watch for drift.

Normal

Both arms stay up equally

Arm Drift ABNORMAL

One arm drifts down or cannot be raised

S - Speech

Instructions: Ask patient to repeat a simple phrase. Listen for slurring or strange words.

Normal

Words are clear and appropriate

Speech Problems ABNORMAL

Slurred speech, wrong words, or unable to speak

T - Time

Instructions: Note exact time symptoms started or last known normal time.

Time Known

Exact onset time documented

Time Unknown ABNORMAL

Onset time uncertain - use last known normal

Assessment Scales

FAST Scale:

Primary prehospital screening (Face, Arms, Speech, Time)

BEFAST Scale:

Enhanced detection including Balance and Eyes (posterior strokes)

Cincinnati Scale:

Research-validated assessment with specific probability calculations

NIHSS (Advanced):

Comprehensive 15-item scale for hospital and advanced providers

Critical Time Windows

Thrombolytics:

4.5 hours from symptom onset (alteplase/tPA)

Endovascular:

6-24 hours for selected patients (thrombectomy)

Golden Hour:

First hour is most critical - "Time is Brain"

Neuroprotection:

Every minute delay = 1.9 million neurons lost

Emergency Actions

• IMMEDIATE transport to stroke center
• Notify receiving facility with ETA
• Establish IV access (avoid affected side)
• Check blood glucose immediately
• Document exact symptom onset time
• Protect airway if decreased consciousness

Assessment Tips

• Use "last known normal" if onset unclear
• Test both arms simultaneously for drift
• Have patient repeat complex phrases
• Check for facial symmetry at rest and active
• Document all findings clearly
• Reassess during transport

Contraindications

• Recent surgery or major trauma
• Active bleeding or blood disorders
• Severe hypertension (>185/110)
• Recent stroke (<3 months)
• Blood glucose <50 or >400 mg/dL
• Recent anticoagulation use

Evidence-Based Practice

This assessment tool implements validated stroke screening scales based on American Heart Association/American Stroke Association guidelines and peer-reviewed research. The Cincinnati Prehospital Stroke Scale has been validated with 66% sensitivity and 87% specificity for stroke detection in the field.

Key Citations: Kothari RU, et al. Cincinnati Prehospital Stroke Scale. Ann Emerg Med. 1999 • American Heart Association Guidelines for Early Management of Acute Ischemic Stroke • BE-FAST vs FAST for acute stroke detection, Venkatesh N, et al. 2019

Clinical Note

Remember "Time is Brain": Stroke is a time-critical emergency where every minute counts. When any stroke screening tool is positive, immediate transport to a comprehensive stroke center is indicated. Contact medical control for guidance on concerning findings or when transport decisions are unclear. This tool is designed to assist clinical decision-making but does not replace clinical judgment and protocols.