Performance of the vision, aphasia, neglect (VAN) assessment within a single large EMS system.
stroke
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
16
12
2020
revised:
06
04
2021
accepted:
12
04
2021
pubmed:
25
4
2021
medline:
23
3
2022
entrez:
24
4
2021
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 33893209
pii: neurintsurg-2020-017217
doi: 10.1136/neurintsurg-2020-017217
pmc: PMC8787821
mid: NIHMS1719183
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
341-345Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR002490
Pays : United States
Informations de copyright
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Prehosp Emerg Care. 2020 Jul-Aug;24(4):500-504
pubmed: 31580180
Stroke. 2017 Oct;48(10):2827-2835
pubmed: 28916666
J Neurointerv Surg. 2020 Mar;12(3):233-239
pubmed: 31484698
JAMA. 2016 Sep 27;316(12):1279-88
pubmed: 27673305
Stroke. 2014 Jan;45(1):87-91
pubmed: 24281224
J Neurointerv Surg. 2019 Nov;11(11):1085-1090
pubmed: 31201289
Stroke. 2019 Jul;50(7):e187-e210
pubmed: 31104615
Stroke. 2020 Nov;51(11):3310-3319
pubmed: 33023425
JAMA Neurol. 2021 Feb 1;78(2):157-164
pubmed: 33252631
J Neurointerv Surg. 2021 Jun;13(6):505-508
pubmed: 32611621
Stroke. 2019 Dec;50(12):e344-e418
pubmed: 31662037
Stroke. 2018 Mar;49(3):565-572
pubmed: 29459391
Stroke. 2015 Jun;46(6):1508-12
pubmed: 25899242
Prehosp Emerg Care. 2021 Jan 12;:1-8
pubmed: 33205683
JAMA Neurol. 2020 Jun 1;77(6):691-699
pubmed: 32250423
Stat Med. 2011 Feb 20;30(4):377-99
pubmed: 21225900
Stroke. 2018 Mar;49(3):e111-e122
pubmed: 29367333
J Neurointerv Surg. 2017 Feb;9(2):122-126
pubmed: 26891627
Stroke. 2020 Mar;51(3):867-875
pubmed: 31964288
Neurology. 2017 May 30;88(22):2123-2127
pubmed: 28455382
J Neurointerv Surg. 2020 Jun;12(6):545-547
pubmed: 32060151
Stroke. 2020 Mar;51(3):742-750
pubmed: 32078485
Curr Atheroscler Rep. 2018 May 21;20(7):34
pubmed: 29781051
Stroke. 2020 Jul;51(7):1951-1960
pubmed: 32568640
J Stroke Cerebrovasc Dis. 2019 Dec;28(12):104469
pubmed: 31680030
J Stroke Cerebrovasc Dis. 2020 Jan;29(1):104478
pubmed: 31704124
J Neurointerv Surg. 2020 Jan;12(1):19-24
pubmed: 31266858
Int J Stroke. 2019 Aug;14(6):592-602
pubmed: 31354081
Front Neurol. 2017 Nov 30;8:651
pubmed: 29250029