การวิจัยเปรียบเทียบเครื่องมือที่ใช้ตรวจคัดกรอง ภาวะหลอดเลือดในสมองขนาดใหญ่ตีบหรืออุดตัน  โดยใช้เครื่องมือ VAN, FAST-ED และ NIHSS ในโรงพยาบาลชัยนาทนเรนทร

Woradad  Kanchanasuvarna

Authors

Woradad Kanchanasuvarna Jainard Narendra Hospital

Keywords:

Stroke, LVOS, NIHSS, FAST-ED, VAN assessment

Abstract

Objective: To compare the screening tools for large vessel occlusion (LVO), using the VAN, FAST-ED, and NIHSS scales, in patients with acute ischemic stroke presenting to Jainard Narendra Hospital.

Method: This retrospective descriptive study involved the analysis of medical records and radiological imaging (CTA, MRA, Angiogram) from 178 patients. The cohort included individuals who presented to Jainard Narendra Hospital between January 1, 2023, and September 30, 2024, with clinical symptoms of acute ischemic stroke within 6 hours of onset. The diagnostic accuracy of the FAST-ED, VAN, and NIHSS screening tools was evaluated against the definitive diagnosis of LVO from imaging, which served as the gold standard.

Results: Of the 178 ischemic stroke patients, 81 (46.8%) were found to have large vessel occlusion. In comparing the performance of the screening tools, the VAN assessment had the highest sensitivity at 90.42% and the highest negative predictive value (NPV) at 88.31%. Conversely, an NIHSS score ≥ 6 had the highest specificity at 89.28% and the highest positive predictive value (PPV) at 87.50%. The FAST-ED scale ≥ 4 showed a sensitivity of 82.97% and a specificity of 70.23%. The accuracy of all three tools was comparable.

Conclusions: The VAN assessment demonstrated the highest sensitivity for detecting large vessel occlusion, which is the most critical attribute for a screening tool to avoid missing patients requiring urgent treatment. Therefore, the VAN assessment is a simple, rapid, and highly effective tool suitable for screening patients in emergency or pre-hospital settings.

Keywords: Stroke, LVOS, NIHSS, FAST-ED, VAN assessment

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