{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T01:07:52Z","timestamp":1788570472456,"version":"build-2803163510"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Several pre-hospital delays prevent stroke patients from arriving within the optimal 4.5-h therapeutic window, including failure to recognize stroke symptoms and lack of urgency in perceiving them as requiring immediate medical attention. Community stroke education is critical in reducing pre-hospital delays. The Face-Arm-Speech-Time (FAST) mnemonic has been the AHA\/ASA\u2019s official stroke warning-signs public education message since 2013. Recently, a more inclusive but potentially harder to remember mnemonic, adding Balance-Eyes (BEFAST), has been proposed to increase the sensitivity of warning-sign messaging in detecting strokes. We undertook a pilot randomized trial to assess the feasibility of, refine methods for, and provide information regarding required sample size for a larger, pivotal randomized trial comparing the retention rate of FAST versus BEFAST.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study randomized adult participants without history of stroke to a comprehensive community stroke education intervention that included the definition of a stroke, its risk factors, outcomes, and either FAST or BEFAST mnemonics and assessed retention after 14\u201321\u202fdays. The primary endpoint was retention of mnemonic letter and warning-sign knowledge. The secondary outcome was improvement at 14\u201321\u202fdays in participant knowledge of stroke definition, risk factors, and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 50 adult participants, mean age was 37.2 (\u00b114.8) and 30 (60%) participants were women. Study procedures were completed in all participants. At initiation, 23 (46%) participants knew the definition of stroke and could describe a mean 1.6 signs, 0.98 risk factors, and 0.74 outcomes. Full mnemonic recall rates at 14\u201321\u202fdays were 68% for FAST and 56% for the BEFAST cohorts (<jats:italic>p<\/jats:italic>\u202f=\u202f0.39). Secondary paired analysis found significant improvements in participant knowledge of stroke signs (to 2.72), risk factors (to 3.30), and outcomes (to 2.24) with <jats:italic>p<\/jats:italic>\u202f=\u202f0.007 or smaller.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This pilot trial demonstrated the feasibility of performing a large, pivotal trial and indicates a sample size of 512 participants is needed to provide sufficient power. The preliminary pilot data suggest a generally higher recall performance in the FAST group. Regardless of the mnemonic taught, participants had significant improvements in their knowledge of stroke signs, risk factors, and outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1624800","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T05:37:43Z","timestamp":1752644263000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["A pilot comparison of the retention rates of FAST and BEFAST stroke warning-sign mnemonics"],"prefix":"10.3389","volume":"16","author":[{"given":"Shujing","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey 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