Vision, Aphasia, Neglect Assessment to Predict Neurosurgical Intervention in Patients with Nontraumatic Intracerebral Hemorrhage

J Stroke Cerebrovasc Dis. 2019 Dec;28(12):104469. doi: 10.1016/j.jstrokecerebrovasdis.2019.104469. Epub 2019 Nov 1.


Background and purpose: The Vision, Aphasia, and Neglect (VAN) screening tool is a simple bedside test developed to identify patients with large vessel occlusion stroke. In the setting of intracerebral hemorrhage (ICH), there are very few bedside predictors of need for neurosurgical interventions other than age and Glasgow Coma Scale (GCS). We aimed to assess the utility of the VAN screening tool in predicting the need for neurosurgical intervention in patients with ICH.

Methods: We accessed sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under receiver operating characteristics curve of VAN for identifying ICH patients who require neurosurgical intervention.

Results: Among 228 ICH patients, 176 were VAN positive and 52 were VAN negative. On unadjusted analyses, VAN positive patients had a significantly higher ICH volume, GCS score, and National Institutes of Health Stroke Scale score (P < .001 for all). As compared to VAN negative patients, significantly higher proportion of VAN positive ICH patients (15.4% versus 32.4%) underwent a neurosurgical procedure such as external ventricular drain (EVD) and/or hematoma evacuation with craniotomy or craniectomy. The VAN screening tool had high sensitivity and NPV (100%) in predicting the need for craniectomy or hematoma evacuation, but had lower sensitivity (87.7%) for any neurosurgical procedure, as 15.4% of VAN negative patients received EVD.

Conclusions: Our study suggests that VAN screening tool can identify high-risk ICH patients who are more likely to undergo craniotomy or craniectomy but is less sensitive to rule out need for EVD.

Keywords: VAN scale; intracerebral hemorrhage; prehospital screen; prehospital stroke.

MeSH terms

  • Aged
  • Aphasia / diagnosis*
  • Aphasia / psychology
  • Cerebral Hemorrhage / diagnosis*
  • Cerebral Hemorrhage / physiopathology
  • Cerebral Hemorrhage / psychology
  • Cerebral Hemorrhage / surgery*
  • Craniotomy*
  • Databases, Factual
  • Decision Support Techniques*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • Vision, Ocular*