Vision, Aphasia, Neglect Assessment for Large Vessel Occlusion Stroke

Navalkele, Digvijaya; Vahidy, Farhaan S; Kendrick, Sarah; Traylor, Angela; Haydel, Micelle J.; Drury, Stacy S.; Martin‐Schild, Sheryl

doi:10.1016/j.jstrokecerebrovasdis.2019.104478

Cited by 10 publications

(9 citation statements)

References 7 publications

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“…A recently published study attempting to validate the vision, aphasia, and neglect screen found a much lower sensitivity of 79% for large vessel occlusion 21 . Our FANG‐D screen sensitivity also exceeds that reported for the RACE, FAST‐ED, and CPSS screens 21 . The distinguishing difference between the FANG‐D screen and vision, aphasia, and neglect screen is that vision, aphasia, and neglect screen requires some arm weakness along with another cortical sign.…”

Section: Discussioncontrasting

confidence: 64%

“…21 Our FANG-D screen sensitivity also exceeds that reported for the RACE, FAST-ED, and CPSS screens. 21 The distinguishing difference between the FANG-D screen and vision, aphasia, and neglect screen is that vision, aphasia, and neglect screen requires some arm weakness along with another cortical sign. Therefore, a limitation of vision, aphasia, and neglect screen and some other large vessel occlusion screens is that they exclude pure aphasia or hemineglect.…”

Section: Discussionmentioning

confidence: 49%

“…We cannot exclude the possibility that some large vessel occlusions included were chronic, but this is a limitation of any study that relies on CTA or digital subtraction angiography for large vessel occlusion confirmation. Finally, we did not include internal carotid artery occlusions limited to the cervical portion of the internal carotid artery in our large vessel occlusion definition, which is consistent with many other studies evaluating large vessel occlusion screen accuracy 21 . We included M2 occlusions in our definition of ACLVOs and did not limit this to the region of the M2 segment for which embolectomy was considered.…”

Section: Resultsmentioning

confidence: 92%

“…Before our study, the vision, aphasia, and neglect screen had the best reported sensitivity for any quantitative or qualitative screen to identify a large vessel occlusion amenable to thrombectomy, 12 but that was reported in a small pilot study in which the vision, aphasia, and neglect screen was applied by specially trained nurses 9 . A recently published study attempting to validate the vision, aphasia, and neglect screen found a much lower sensitivity of 79% for large vessel occlusion 21 . Our FANG‐D screen sensitivity also exceeds that reported for the RACE, FAST‐ED, and CPSS screens 21 .…”

Section: Discussionmentioning

confidence: 91%

“…Finally, we did not include internal carotid artery occlusions limited to the cervical portion of the internal carotid artery in our large vessel occlusion definition, which is consistent with many other studies evaluating large vessel occlusion screen accuracy. 21 We included M2 occlusions in our definition of ACLVOs and did not limit this to the region of the M2 segment for which embolectomy was considered. Nonetheless, there is no established criterion for this designation and any M2 segment occlusion is consistent with the AC vessels now considered eligible for mechanical thrombectomy in the most recent AHA/ASA guidelines.…”

Section: Limitationsmentioning

confidence: 99%

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Test characteristics of a 5‐element cortical screen for identifying anterior circulation large vessel occlusion ischemic strokes

et al. 2020

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Objective Stroke severity screens typically include cortical signs, such as field cut, aphasia, neglect, gaze preference, and dense hemiparesis (FANG‐D). The accuracy and reliability of these signs, when assessed by emergency physicians, to identify patients with anterior circulation large vessel occlusion (ACLVO) acute ischemic stroke (AIS) is unknown. We hypothesized that the FANG‐D screen applied by emergency physicians would be sensitive and reliable for identifying ACLVO AIS. Methods We conducted a prospective cohort study enrolling consecutive patients with suspected AIS presenting within 4.5 hours of last known well to the emergency department (ED). Emergency physicians performed the FANG‐D screen prior to, and blinded to the results of, imaging. The imaging standard was defined as a non‐contrast computed tomography (CT) for identifying hemorrhage and CT angiography for identifying large vessel occlusion. ACLVO was defined as an occlusion of the internal carotid artery, the middle cerebral artery, or its first branch. A convenience sample of patients had a duplicate FANG‐D screen performed by a second emergency physician to assess interobserver agreement. Results We performed 608 FANG‐D assessments on 491 patients presenting to the ED, of whom 64 (10%) had an ACLVO. FANG‐D had a sensitivity of 91% (confidence interval [CI] = 81%–96%) and a specificity of 35% (CI = 31%–39%) for identifying ACLVO. Interobserver agreement was tested on 133 patients and was found to be substantial, with a Fleiss’ kappa of 0.77 (CI = 0.64–0.88). Conclusions The FANG‐D screen is a sensitive test for identifying ACLVO when performed by emergency physicians and demonstrates substantial interrater reliability.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 49%

Section: Resultsmentioning

confidence: 92%