For healthcare professionals
FAST-ED (Field Assessment Stroke Triage for Emergency Destination)
FAST-ED is a prehospital stroke score designed to flag a possible large vessel occlusion (LVO). It adds five findings, facial palsy, arm weakness, speech changes, eye deviation, and denial or neglect, for a total of 0 to 9. A score of 4 or more is the published cut-off. This calculator is written for clinicians and EMS. It is not a self-check and not a diagnosis.
Score the five items
Item names and points as printed in Budincevic and colleagues (Budincevic 2022). The scoring criteria for each level are in the original paper by Lima and colleagues (Lima 2016). The short test notes are our own. Nothing you enter leaves this page.
What you will see
The FAST-ED total from 0 to 9 and whether it reaches the published cut-off of 4 for a possible large vessel occlusion.
Educational only, not medical advice. A score supports, and does not replace, clinical judgment and local stroke triage protocols.
Source
Lima FO et al., Stroke 2016 (the original scale), cited only. Item names and points as printed in Budincevic H et al., Medicina (Kaunas) 2022, the 0 to 9 range in Heydari F et al., BMC Emerg Med 2026, and the cut-off of 4 in Duvekot MH et al., Eur Stroke J 2021, all open access (CC BY 4.0). The scoring criteria for each level are in Lima 2016.
Validated in
Designed by Lima and colleagues (2016) to detect large vessel occlusion before hospital. In the open studies cited here: 3,021 adults treated for an anterior circulation occlusion in the Netherlands, with FAST-ED rebuilt from admission NIHSS scores (Duvekot 2021) and patients with suspected stroke who had brain MRI in emergency departments in Isfahan, Iran (Heydari 2026).
Limits
A triage aid for clinicians and EMS, not a diagnosis. At a cut-off of 4 it misses part of all occlusions and close to half of distal (M2) occlusions, and many people at or above it have no occlusion. It does not tell a stroke from a bleed or a stroke mimic. Vessel imaging decides.
How the scale is scored
FAST-ED has five items: facial weakness (0 to 1), arm weakness (0 to 2), speech changes (0 to 2), eye deviation (0 to 2) and anosognosia or neglect (0 to 2) (Budincevic 2022), for a total of 0 to 9 (Heydari 2026). Lima and colleagues designed it in 2016 as a simple prehospital scale to detect large vessel occlusion strokes (Lima 2016). It puts weight on cortical signs such as eye deviation and neglect (Heydari 2026).
| Item | Points |
|---|---|
| Facial palsy | 0 to 1 |
| Arm weakness | 0 to 2 |
| Speech changes | 0 to 2 |
| Eye deviation | 0 to 2 |
| Denial or neglect | 0 to 2 |
| Total | 0 to 9. A score of 4 or more is the cut-off for a possible LVO. |
Item names and point ranges follow Table 1 of Budincevic and colleagues (Budincevic 2022). No open access paper we could reuse prints the criteria for each point level, so this page does not restate them: the scoring criteria for each level are in the original paper by Lima and colleagues (Lima 2016). Use it and your local protocol for the exact test steps.
The cut-off of 4
Studies of FAST-ED use 4 or more to flag a possible large vessel occlusion (Duvekot 2021). One review table prints the cut-off as ">4" (Budincevic 2022); this calculator uses 4 or more, as in the Dutch comparison study. In a Dutch registry of patients with a treatable occlusion, a score of 4 or more had a sensitivity of 0.78 overall but 0.55 for more distal M2 occlusions (Duvekot 2021). A review gives a sensitivity of 61% and a specificity of 89% for large vessel occlusion stroke (Budincevic 2022). In Iranian emergency departments, a lower cut-off of 3 or more was used to detect acute ischemic stroke of any kind, with a sensitivity of 74.7% and a specificity of 77.4% (Heydari 2026). So a score under 4 does not rule out an occlusion, and local protocols, time from onset and imaging guide the final decision.
Citation check
The item names, points and cut-off on this page were checked against the full text of the open access papers above in Europe PMC: the items and ranges against Budincevic (2022), the 0 to 9 range against Heydari (2026) and the cut-off of 4 against Duvekot (2021), each under a Creative Commons Attribution 4.0 (CC BY 4.0) license. The original paper by Lima (2016) is cited, not quoted.
Related stroke tools
For a five-item score from 0 to 9 with a cut-off of 5, see the RACE scale. For a three-item motor score from 0 to 5 with a cut-off of 4, see the Los Angeles Motor Scale (LAMS). For the three-sign face, arm and speech screen used before hospital, see the Cincinnati Prehospital Stroke Scale. For a yes or no screen that needs arm weakness plus visual disturbance, aphasia or neglect, see the VAN stroke screen. To score the full neurological deficit on arrival, use the NIH Stroke Scale (NIHSS) calculator. Other bedside scores are listed under For healthcare professionals.
Sources
- Budincevic H, Mestrovic A, Demarin V. Stroke scales as assessment tools in emergency settings: a narrative review. Medicina (Kaunas). 2022;58(11):1541. doi:10.3390/medicina58111541. PMID 36363498. Open access (CC BY 4.0). Table 1: FAST-ED items and ranges, facial weakness 0-1, arm weakness 0-2, speech changes 0-2, eye deviation 0-2, anosognosia/neglect 0-2; sensitivity 61% and specificity 89% for large vessel occlusion stroke. pmc.ncbi.nlm.nih.gov/articles/PMC9696547/
- Duvekot MH, Venema E, Lingsma HF, et al. Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations. Eur Stroke J. 2021;6(2):194-204. doi:10.1177/23969873211015861. PMID 34414295. Open access (CC BY 4.0). Table 2: RACE 5 or more, sensitivity 0.75 in the full cohort and 0.48 for M2 occlusions. pmc.ncbi.nlm.nih.gov/articles/PMC8370085/
- Heydari F, Marzban M, Esmailian M, Boroumand AB, Najafi A, Isfahani MN, et al. Diagnostic accuracy of the ROSIER scale for detecting acute ischemic stroke: a comparison with FAST-ED, CPSS, and reference criteria. BMC Emerg Med. 2026;26:252. doi:10.1186/s12873-026-01654-0. PMID 42380816. Open access (CC BY 4.0). Methods: FAST-ED has five elements scored 0 to 9; Table 2: at 3 or more, sensitivity 74.7% and specificity 77.4% for acute ischemic stroke on MRI. pmc.ncbi.nlm.nih.gov/articles/PMC13587276/
- Lima FO, Silva GS, Furie KL, Frankel MR, Lev MH, Camargo ECS, et al. Field Assessment Stroke Triage for Emergency Destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes. Stroke. 2016;47(8):1997-2002. doi:10.1161/STROKEAHA.116.013301. PMID 27364531. Original scale (cited, not quoted). doi.org/10.1161/STROKEAHA.116.013301
- Centers for Disease Control and Prevention. Signs and Symptoms of Stroke. www.cdc.gov/stroke/signs-symptoms/index.html
- National Institute of Neurological Disorders and Stroke (NIH). Transient Ischemic Attack (TIA). www.ninds.nih.gov/health-information/disorders/transient-ischemic-attack
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-04. Spotted an error? See About.