Abstract
Objective:
Describe the need for a large vessel occlusion screening tool in stroke management.
Present the advantages of the FAST VAN tool compared to other tools.
Summarize the data when the tool was applied prospectively.
Background: Acute stroke management has been revolutionized by recent clinical trials demonstrating significant reduction in morbidity and mortality associated with endovascular thrombectomy for severe strokes presenting with a large vessel occlusion (LVO). There is a urgent need to identify potential LVO patients so they can be transported directly to a tertiary stroke center providing endovascular therapy. An array of screening tools have been developed that are often cumbersome, require training, and do not identify clinical features specific to large vessel stroke. We developed a simplified tool requiring minimal training, no scoring, and is specific to LVO syndromes. A previous retrospective analysis of this tool identified a high sensitivity and acceptable specificity.
Design/Methods: We prospectively evaluated 172 consecutive stroke cases at out center who were reported as having VAN symptoms or signs, by any member of the care continuum, and with no VAN training. We then compared this to the presence or absence of LVO on CTA.
Results: Eighty patients were positive for LVO, whereas 58 were found to have no LVO. There were 11 true false positives after reviewing the cases. The overall positive predicative value was 58% and when including only the true false positives, the PPV rose to 88%.
Conclusions: The FAST VAN tool for clinically identifying LVO is easy to implement even without specific training, is sensitive, and has an acceptable PPV. It is reassuring that all false positive patients did need to be assessed at our center (compared to the referring sites), leaving little concern for excessive unnecessary bypass and expense to the system.
Disclosure: Dr. Wasyliw has nothing to disclose. Dr. Whelan has nothing to disclose. Dr. Kelly has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Pneumbra and Medtronic. Dr. Davy has nothing to disclose. Dr. Hunter has nothing to disclose.
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