Background There is limited evidence on the performance of emergent large-vessel occlusion (LVO) stroke screening tools when used by emergency medical services (EMS) and emergency department (ED) providers. We assessed the validity and predictive value of the vision, aphasia, neglect (VAN) assessment when completed by EMS and in the ED among suspected stroke patients.
Methods We conducted a retrospective study of VAN performed by EMS providers and VAN inferred from the National Institutes of Health Stroke Scale performed by ED nurses at a single hospital. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VAN by EMS and in the ED for LVO and a combined LVO and intracerebral hemorrhage (ICH) outcome.
Results From January 2018 to June 2020, 1,547 eligible patients were identified. Sensitivity and specificity of ED VAN were similar for LVO (72% and 74%, respectively), whereas EMS VAN was more sensitive (84%) than specific (68%). PPVs were low for both EMS VAN (26%) and ED VAN (21%) to detect LVO. Due to several VAN-positive ICHs, PPVs were substantially higher for both EMS VAN (44%) and ED VAN (39%) to detect LVO or ICH. EMS and ED VAN had high NPVs (97% and 96%, respectively).
Conclusions Among suspected stroke patients, we found modest sensitivity and specificity of VAN to detect LVO for both EMS and ED providers. Moreover, the low PPV in our study suggests a significant number of patients with non-LVO ischemic stroke or ICH could be over-triaged with VAN.
Data availability statement
Data are available upon reasonable request. The data are deidentified, retrospective from suspected stroke patients at a single center.
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Contributors MDP, JT, OK-H: conception and design of the study. JT, JGG, JGW, EL, MB, MAM, CL, LM, TB, OK-H: acquisition of data. MDP, JT: analysis of data. MDP: drafting of the manuscript. All authors: interpretation of data, critical review, and final approval of the manuscript.
Funding MDP is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR002490.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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