Touro Infirmary and New Orleans East Hospital, New Orleans, Louisiana.
University of Texas, Health Science Center at Houston, Houston, Texas.
J Stroke Cerebrovasc Dis. 2020 Jan;29(1):104478. doi: 10.1016/j.jstrokecerebrovasdis.2019.104478. Epub 2019 Nov 6.
Vision, Aphasia, Neglect (VAN) is a large vessel occlusion (LVO) screening tool that was initially tested in a small study where emergency department (ED) nurses were trained to perform VAN assessment on stroke code patients. We aimed to validate the VAN assessment in a larger inpatient dataset.
We utilized a large dataset and used National Institute of Health Stroke Scale (NIHSS) performed by physicians to extrapolate VAN. VAN was compared to NIHSS greater than or equal to 6 and established prehospital LVO screening tools including Rapid Arterial Occlusion Evaluation scale (RACE), Field Assessment Stroke Triage for Emergency Destination (FAST-ED), and Cincinnati Pre-hospital Stroke Scale (CPSS). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under receiver operating characteristics curve was calculated to estimate the predictive value of LVO.
VAN was comparable in sensitivity (79% versus 80%) and NPV (88% versus 87%) to NIHSS greater than or equal to 6. It was superior in specificity (69% versus 57%), PPV (53% versus 46%) and accuracy to NIHSS greater than or equal to 6 (72% versus 64%) with significant receiver operating curve (.74 versus .69, P = .02). VAN also had comparable area under the curve when compared to RACE, FAST-ED, and CPSS however slightly lower accuracy (69%-73%) compared to RACE (76%), FAST-ED (77%), and CPSS (75%). VAN had the highest NPV among all screening assessments (88%).
VAN is a simple screening tool that can identify LVOs with adequate accuracy in hospital setting. Future studies need to be conducted in prehospital setting to validate its utility to detect LVOs in the field.
视觉、失语症、忽视（VAN）是一种大血管闭塞（LVO）筛查工具，最初在一项小型研究中进行了测试，该研究中急诊护士接受了培训，以对卒中编码患者进行 VAN 评估。我们旨在通过更大的住院患者数据集来验证 VAN 评估。
我们利用了一个大型数据集，并使用医生进行的国立卫生研究院卒中量表（NIHSS）来推断 VAN。VAN 与 NIHSS 评分大于或等于 6 分进行比较，并与包括 Rapid Arterial Occlusion Evaluation scale（RACE）、Field Assessment Stroke Triage for Emergency Destination（FAST-ED）和 Cincinnati Pre-hospital Stroke Scale（CPSS）在内的既定院前 LVO 筛查工具进行比较。计算敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、准确性和接受者操作特征曲线下面积，以评估 LVO 的预测价值。
VAN 在敏感性（79%对 80%）和 NPV（88%对 87%）方面与 NIHSS 评分大于或等于 6 分相当。它在特异性（69%对 57%）、PPV（53%对 46%）和准确性（72%对 64%）方面优于 NIHSS 评分大于或等于 6 分，差异具有统计学意义（.74 对.69，P=0.02）。与 RACE、FAST-ED 和 CPSS 相比，VAN 的曲线下面积也相当，但准确性略低（69%-73%对 RACE 的 76%、FAST-ED 的 77%和 CPSS 的 75%）。VAN 在所有筛查评估中具有最高的 NPV（88%）。
VAN 是一种简单的筛查工具，可在医院环境中以足够的准确性识别 LVO。需要在院前环境中进行进一步的研究，以验证其在现场检测 LVO 的实用性。
