RT Journal Article SR Electronic T1 Performance of the vision, aphasia, neglect (VAN) assessment within a single large EMS system JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP neurintsurg-2020-017217 DO 10.1136/neurintsurg-2020-017217 A1 Mehul D Patel A1 Jackie Thompson A1 José G Cabañas A1 Jefferson G Williams A1 Erin Lewis A1 Michael Bachman A1 Mahmoud Al Masry A1 Charles LaVigne A1 Leonardo Morantes A1 Tibor Becske A1 Omar Kass-Hout YR 2021 UL http://jnis.bmj.com/content/early/2021/04/22/neurintsurg-2020-017217.abstract AB 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 are available upon reasonable request. The data are deidentified, retrospective from suspected stroke patients at a single center.