Background: Acute stroke management has been revolutionized by recent clinical trials demonstrating significant reduction in morbidity and mortality associated with endovascular thrombectomy for severe strokes presenting with a large vessel occlusion (LVO). There is an urgent need to identify potential LVO patients so they can be transported directly to a tertiary stroke center providing endovascular therapy. An array of screening tools have been developed that are often cumbersome, require training, and do not identify clinical features specific to large vessel stroke. We developed a simplified tool requiring minimal training, no scoring, and is specific to LVO syndromes.  A previous retrospective analysis of this tool identified a high sensitivity and acceptable specificity.	 
Methods: We prospectively evaluated 172 consecutive stroke cases at our center who were reported as having VAN symptoms or signs, by any member of the care continuum, and with no training. We then compared this to the presence or absence of LVO.	 
Results:	Eighty patients were positive LVO, whereas 58 were found to have no LVO. There were 11 true false positives after reviewing cases. The overall positive predictive value was 58% and when including only the true false positives, the PPV rose to 88%.	 
Conclusion(s): The FAST VAN tool for clinically identifying LVO is easy to implement even without specific training, is sensitive, and has an acceptable PPV. It is reassuring that all false positive patients did need to be assessed at our center vs the referring sites, leaving little concern for excessive unnecessary bypass and expense to the system.

The FAST VAN Tool for Identifying Large Vessel Occlusion in Acute Stroke