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Including isolated aphasia improves sensitivity and negative predicative value for large vessel occlusion screening.

Authors :
Joiner L
Ryan J
Fiesta M
Source :
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2024 Aug; Vol. 33 (8), pp. 107840. Date of Electronic Publication: 2024 Jun 28.
Publication Year :
2024

Abstract

Background: Large Vessel Occlusion (LVO) screening tools provide objective assessments to guide diagnostic decisions during acute stroke activations. The Stroke VAN screening tool includes weakness, vision, aphasia, and neglect; however, only screens positive if weakness is present regardless of presence of other symptoms including isolated aphasia. The purpose of this project was to evaluate wAve, a modified Stroke VAN screening tool. WAve includes components of VAN with emphasis on isolated aphasia.<br />Methods: We conducted a retrospective cohort study on 376 persons who presented with stroke symptoms within 24 h of last known well (LKW) to the Emergency Department of an urban comprehensive stroke center in north central Texas between July 2019 and January 2020. Comparison of VAN and wAve predictive values was calculated using Chi square analysis. Sensitivity and specificity was checked by using MedCalc software. Data from the electronic medical record was obtained for analysis including a documented wAve score and a calculated VAN score. Results of CT angiogram diagnostic testing was used to determine congruence of screening results with evidence of LVO. Power analysis described by Hajian- Tilaki was used to estimate study size.<br />Results: Results included 192 positive wAve screens and 184 negative wAve screens compared to 152 positive VAN screens and 224 negative VAN screens. The sensitivities for wAve and VAN were 89 % and 80 % respectively. Negative predictive values for wAve and VAN were 97 % and 95 % respectively. In isolated aphasic person, one of eight presented with a LVO and received intervention.<br />Conclusion: The team discovered more LVOs were identified with wAve than VAN in persons exhibiting isolated aphasia symptoms. Larger studies are needed to understand the role isolated aphasia plays in LVO detection.<br />Competing Interests: Declaration of competing interest We declare no competing interests.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1532-8511
Volume :
33
Issue :
8
Database :
MEDLINE
Journal :
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
Publication Type :
Academic Journal
Accession number :
38945416
Full Text :
https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107840