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Published on: July 2, 2013
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Including isolated aphasia improves sensitivity and negative predicative value for large vessel occlusion screening
Leora Joiner1, James Ryan2, Matthew Fiesta3
1Stroke Program Coordinator at Texas Health Fort Worth Hospital, 1301 Pennsylvania Ave, Fort Worth, TX 76104, United States.
Summary
The wAve screening tool identified more large vessel occlusions (LVOs) than the Stroke VAN tool, particularly in patients with isolated aphasia. This highlights the importance of considering aphasia in acute stroke screening.
Area of Science:
- Neurology
- Emergency Medicine
- Radiology
Background:
- Large Vessel Occlusion (LVO) screening tools are crucial for acute stroke diagnosis.
- The Stroke VAN tool requires weakness for a positive screen, potentially missing cases with isolated aphasia.
- The wAve tool modifies VAN to include isolated aphasia for improved screening.
Purpose of the Study:
- To evaluate the efficacy of the wAve screening tool compared to the Stroke VAN tool.
- To assess the detection rates of LVOs, especially in patients with isolated aphasia.
Main Methods:
- A retrospective cohort study of 376 patients with stroke symptoms within 24 hours of last known well.
- Comparison of predictive values, sensitivity, and specificity between wAve and VAN using Chi-square analysis and MedCalc software.
- CT angiogram results were used to confirm LVO presence and correlate with screening tool outcomes.
Main Results:
- wAve yielded more positive screens (192) than VAN (152).
- wAve demonstrated higher sensitivity (89%) and negative predictive value (97%) compared to VAN (80% and 95%, respectively).
- One of eight patients with isolated aphasia screened positive with wAve and received intervention for LVO.
Conclusions:
- The wAve tool is more effective than VAN in identifying LVOs, particularly in patients with isolated aphasia.
- Further research is needed to fully understand the significance of isolated aphasia in LVO detection.
