Abstract TP42: Van- Training Of Emergency Medical Services To Identify LVO And Potential Thrombectomy Patients In The Field

Abstract

Background and Purpose: Stroke is a leading cause of disability and mortality in the United States. Rapid identification of stroke symptoms in the prehospital setting especially symptoms of a large vessel occlusion (LVO) may minimize the time to endovascular treatment and improve outcomes. Several stroke assessment tools are available to EMS identify symptoms of stroke and stroke severity. No one tool has proven to be superior to identify possible LVO. The primary objective of this study is to determine the accuracy of the VAN (vision, aphasia, and neglect) prehospital EMS assessment tool to predict LVO and identify patients potentially eligible for mechanical thrombectomy. Methods: Study investigators trained Central EMS and AirEvac personnel in use of the VAN screening tool over a 2-month period which consisted of instructional videos, oral presentations, and case scenarios. A post-training quiz was administered with a passing score of 80% required. Personnel were trained to assess and report the patient as “VAN positive” or “VAN negative” in the prehospital report and electronic document. This assessment was compared with CTA results and cerebral angiography for presence or absence of thrombus, as well as pre and post TICI result if thrombectomy was performed. Additionally, we compared door-to-groin puncture time for VAN positive patients with retrospective data from patients with LVO prior to VAN reporting. Results: An interim analysis of 147 patients evaluated with the VAN tool demonstrated 92.9% sensitivity in identifying LVO, 70.6% specificity, and 73.2% accuracy rate. Eligibility for thrombectomy demonstrated 91.7% sensitivity, 69.4% specificity, and accuracy rate of 71.5%. Conclusions: The VAN assessment tool, while still requiring further data, has shown promise in identifying LVO and eligibility for thrombectomy. The study will continue until 300 participants have been enrolled with full presentation of data at a future date. Registration: Registration-URL: http://www.clinicaltrials.gov ; Unique identifier: NCT04951518