External Validation of Stroke Screening Tools for Emergent Large Vessel Occlusion (ELVO)
Authors
İbrahim Ulaş Özturan, Duygu Ferek Emir, Adnan Karadaş, et al.
Journal
Journal of Emergency Medicine, 2024
Conclusion
- Utility in Practice: VAN, VES, and LARIO provide diagnostic performance comparable to NIHSS, but with the advantage of simplicity and faster application.
- Clinical Implications: These tools can support rapid triage of suspected ELVO in prehospital or ED settings, ensuring timely and appropriate interventions.
- Specific Recommendations:
- VAN: Balanced sensitivity and specificity, suitable for general use.
- VES: Higher sensitivity, useful for identifying a larger pool of potential ELVO cases.
- LARIO: High specificity, best for confirming ELVO diagnosis.
Methods
- Study Design: Prospective, multicenter, cross-sectional study.
- Setting: Five EDs of tertiary stroke centers between June and October 2023.
- Participants: 614 patients with suspected acute ischemic stroke.
- Screening Tools Evaluated:
- VAN
- VES
- LARIO
- NIHSS (used as reference).
- Outcome: Diagnostic performance of each tool in predicting ELVO.
Results
- ELVO Prevalence: 23.5% of the study population.
- Diagnostic Performance:
- VAN:
- Sensitivity: 70.1%
- Specificity: 78.7%
- Area under the curve (AUC): 0.752
- VES:
- Sensitivity: 79.1%
- Specificity: 63.4%
- AUC: 0.746
- LARIO:
- Sensitivity: 56.3%
- Specificity: 86.0%
- AUC: 0.801
- NIHSS:
- AUC: 0.805
- Comparisons:
- LARIO and NIHSS demonstrated similar diagnostic performance (p = 0.7).
- VES had modestly poorer performance compared to NIHSS (p < 0.001).
Ozturan, I.U., Emir, D.F., Karadaş, A., Özturan, C.A., Durmuş, U., Doğan, N.Ö., Yaka, E., Yılmaz, S. and Pekdemir, M., 2024. External Validation of Vision, Aphasia and Neglect, Ventura Emergent Large Vessel Occlusion and Large Artery Intracranial Occlusion Screening Tools for Emergent Large Vessel Occlusion Stroke: A Multicenter, Prospective, Cross-Sectional Study. The Journal of Emergency Medicine.