VAN Stroke Scale
The VAN stroke scale quickly identifies large vessel occlusions (LVO) in stroke patients by assessing Vision, Aphasia, and Neglect, guiding urgent care.
Fact Checked by RJ Gumban.
What is the VAN screening tool?
The VAN screening tool is a clinical assessment method used primarily in the evaluation of stroke patients, specifically to identify large vessel occlusion (LVO) strokes. LVO strokes are caused by a blockage in one of the major arteries of the brain, and they require rapid identification and treatment, often including endovascular therapy.
The acronym "VAN" stands for:
- Vision: This component assesses visual field defects. Patients are evaluated for any loss of vision or visual field cuts, which can indicate an issue with certain brain regions like the occipital lobe or specific large vessels like the posterior cerebral artery.
- Aphasia: This part of the assessment focuses on language. Aphasia refers to the impairment of language ability. The evaluation might include tasks like naming objects, repeating phrases, or following commands. Speech and language comprehension issues can point to dysfunction in brain areas such as the temporal or frontal lobes, often supplied by the middle cerebral artery.
- Neglect: This component assesses signs of neglect, a condition where the patient ignores or is unaware of one side of their body or the space around them. Neglect can be a sign of a stroke in the brain's right hemisphere, which may affect awareness and attention to the left side of the body and environment.
The VAN screening tool is specifically designed to quickly identify strokes that might benefit from advanced treatments like thrombectomy (a procedure to remove a blood clot from a blood vessel). It's valuable because it focuses on identifying symptoms associated with blockages in large vessels, which are crucial to recognize early for effective treatment.
In clinical settings, emergency medical services (EMS) personnel, nurses, and physicians often use the VAN tool to rapidly assess stroke symptoms and expedite decision-making regarding stroke care, particularly in deciding whether to transfer a patient to a comprehensive stroke center capable of performing endovascular treatments.
Printable VAN Stroke Scale
Download this VAN Stroke Scale used primarily in the evaluation of stroke patients, specifically to identify large vessel occlusion (LVO) strokes.
When to use this assessment
The VAN (Vision, Aphasia, Neglect) assessment is specifically used in the following situations:
- Suspected stroke cases: The VAN assessment is most commonly used when a stroke is suspected. It helps to quickly identify symptoms that are indicative of a large vessel occlusion (LVO) stroke. LVO strokes are severe and often require rapid, specialized treatment.
- Pre-hospital screening: Emergency medical services (EMS) personnel may use the VAN assessment in pre-hospital settings, such as when responding to a call for a person with sudden onset neurological symptoms. A quick assessment can help decide the urgency and the appropriate medical facility for treatment (such as a comprehensive stroke center).
- Initial hospital evaluation: In the emergency department, healthcare professionals use the VAN assessment to evaluate patients presenting with acute neurological deficits. It aids in rapidly identifying potential LVO strokes, guiding further diagnostic imaging and treatment decisions.
- Triage for advanced imaging and treatment: The VAN assessment can assist in triaging patients for urgent advanced imaging, like CT angiography or MRI, to confirm the diagnosis of an LVO stroke. It also helps decide about advanced treatments such as intravenous thrombolysis or mechanical thrombectomy.
- Monitoring in hospital settings: In hospitals, especially in stroke units or neurological wards, the VAN assessment can be used to monitor patients at risk of stroke or those who have had a stroke to quickly identify any worsening or new onset of symptoms.
- Telemedicine assessments: When a stroke specialist is not immediately available on-site, the VAN assessment can be used as part of a telemedicine consultation to assess patients remotely and make recommendations regarding their care.
The VAN assessment is a critical tool in rapidly identifying and managing strokes, particularly LVO strokes, where time is a crucial factor in treatment and outcome. It is designed to be simple and quick, allowing for its use in a variety of clinical and pre-hospital settings.
VAN Stroke Scale example (sample)
You can download a free VAN stroke assessment example sample by following this link. This example provides a practical illustration of how the VAN stroke scale is used to evaluate patients suspected of having a stroke. The VAN assessment focuses on three critical areas: Vision, Aphasia, and Neglect, and is instrumental in the rapid identification of strokes, particularly those caused by large vessel occlusions.
The downloadable example is an invaluable resource for healthcare professionals, including those in emergency medicine and prehospital care, offering a clear and concise template for conducting this essential stroke assessment.
Download this free VAN stroke assessment example here
Understanding the results
Interpreting the results of the VAN (Vision, Aphasia, Neglect) screening tool is crucial for identifying the possibility of a Large Vessel Occlusion (LVO) stroke and determining the appropriate course of action. Here’s how to understand the results:
Vision (V):
- Normal vision: If the patient has no visual field deficits in either eye, this part of the assessment is considered normal.
- Abnormal vision: Any loss or partial loss of vision, such as hemianopia (loss of half of the visual field in one or both eyes) or quadrantanopia (loss of a quarter of the visual field), is abnormal. Abnormal results suggest a possible involvement of the visual pathways in the brain, which can be due to an LVO stroke.
Aphasia (A):
- No aphasia: If the patient can understand spoken language, speak fluently, and repeat sentences correctly, the aphasia assessment is considered normal.
- Presence of aphasia: Difficulties in understanding language (receptive aphasia), speaking (expressive aphasia), or repeating phrases (indicative of a more global aphasia) are abnormal findings. Aphasia often points to dysfunction in the brain's language centers, which may be due to an LVO stroke, typically in the left hemisphere.
Neglect (N):
- No neglect: If the patient shows equal attention to both sides of space and body, responding appropriately to stimuli, this part of the assessment is normal.
- Presence of neglect: This is abnormal if the patient ignores or is unaware of one side of their body or space, especially when it comes to bilateral simultaneous stimulation. Neglect, particularly of the left side, often indicates a stroke in the right hemisphere.
Interpreting the overall VAN results
- All components normal: If the patient has normal findings in vision, aphasia, and neglect assessments, it decreases the likelihood of an LVO stroke. However, this does not rule out a stroke entirely, and further evaluation may still be necessary based on other symptoms and risk factors.
- Any abnormal component: If any of the VAN components (vision, aphasia, neglect) are abnormal, it raises suspicion for an LVO stroke. This necessitates urgent further assessment, including neuroimaging (like a CT scan or MRI) to confirm the diagnosis and assess the extent of the stroke.
- Multiple abnormal components: The presence of abnormalities in more than one component of the VAN assessment significantly increases the likelihood of an LVO stroke. This is a medical emergency requiring immediate intervention, often including rapid transfer to a specialized stroke center for possible endovascular treatment (like mechanical thrombectomy).
Next steps
After conducting the VAN stroke scale, the general steps include:
- Assessment interpretation: Evaluate VAN results to identify potential LVO stroke.
- Medical response activation: If LVO stroke is suspected, activate a stroke code for immediate response.
- Comprehensive neurological evaluation: Conduct a full neurological examination, potentially including other stroke scales such as the Cincinnati Stroke Scales or the NIHSS Stroke Scale.
- Advanced imaging: Perform urgent brain imaging, like CT or MRI, to confirm diagnosis.
- Stroke team consultation: Consult with a multidisciplinary stroke team for treatment planning.
- Treatment decision: Decide on treatment, considering thrombolytic therapy or mechanical thrombectomy as options.
- Specialized care transfer: Transfer to a stroke center if necessary for advanced care.
- Monitoring and supportive care: Provide continuous monitoring and manage vital functions.
- Rehabilitation and education: Plan for rehabilitation and educate the patient and family about stroke recovery, using resources like the Stroke Nursing Care Plan and the Stroke Impact Scale.
- Secondary stroke prevention: Initiate measures to reduce the risk of another stroke.
- Follow-up planning: Arrange for ongoing care and follow-up appointments.
- These steps ensure comprehensive care and management for stroke patients, from initial assessment to rehabilitation and prevention of future strokes.
Why use Carepatron as your cognitive testing software?
Using Carepatron as your cognitive testing software offers several compelling advantages, particularly for healthcare practitioners specializing in cognitive assessments and therapies. Here's why Carepatron stands out as a suitable choice for cognitive testing needs:
- Tailored for cognitive assessment needs: Carepatron provides tools and features specifically designed for cognitive testing. This ensures that the software meets the nuanced requirements of cognitive assessments, including various tests and measurement scales.
- Integrated clinical documentation: The platform offers robust clinical documentation capabilities, allowing practitioners to efficiently record and manage test results. This is crucial for tracking patient progress and adapting treatment plans accordingly.
- Secure electronic health records (EHR): With a HIPAA-compliant Electronic Health Records system, Carepatron ensures that all cognitive test data and patient information are stored securely. This level of security is vital for maintaining patient confidentiality and complying with healthcare regulations.
- Efficient practice management: Carepatron's practice management software streamlines administrative tasks, such as scheduling, billing, and client communication. This efficiency frees up more time for practitioners to focus on patient care and cognitive assessments.
- Telehealth capabilities: The telehealth feature enables remote cognitive assessments and consultations, making it easier for patients to access these services regardless of their location or mobility.
Carepatron offers a comprehensive, secure, and user-friendly solution for cognitive testing, encompassing everything from assessment administration to data management. Its blend of specialized features, efficient practice management, and telehealth capabilities make it an ideal choice for healthcare providers looking to enhance their cognitive assessment services.
Commonly asked questions
The VAN Stroke Scale is a rapid assessment tool used by clinical teams, particularly in the prehospital setting, to identify signs of emergent large vessel occlusion (ELVO) in acute ischemic stroke patients. It focuses on three key areas: Vision, Aphasia, and Neglect. This tool aids emergency medical services (EMS) in early stroke code activation and mobilizing resources for patients who may require rapid endovascular treatment.
Unlike the Cincinnati Prehospital Stroke Scale and the Los Angeles Motor Scale, the VAN Stroke Scale specifically targets symptoms of large vessel occlusion strokes, such as vision disturbance, forced gaze, and cortical symptoms. While other scales focus more on general stroke indicators like facial droop, arm weakness, and speech difficulties, VAN is more focused on identifying patients who might benefit from advanced vessel imaging and treatments like thrombectomy.
The positive predictive value (PPV) of the VAN Stroke Scale indicates the likelihood that patients with a positive VAN test genuinely have a large vessel occlusion stroke. Similarly, the negative predictive value (NPV) reflects the probability that VAN-negative patients do not have an ELVO. These values vary depending on the population and setting, with studies like prospective prehospital cohort studies providing specific data. Generally, VAN is known for a reasonable PPV and NPV, but it should be used with other clinical severity indices.
