Abstract TP445: Utility of VAN Assessment for Early Identification of Patients with Intracerebral Hemorrhage

Background: The Vision, Aphasia, Neglect (VAN) assessment has been demonstrated as highly sensitive for detection of large vessel occlusion in acute ischemic stroke patients. As a rapidly performed, highly accurate assessment, many emergency medical services have begun utilizing the VAN as a screening tool to help triage patients to endovascular-capable facilities. We previously demonstrated that VAN can distinguish neurosurgical ICH patients from non-surgical ICH patients. Methods: This retrospective study utilized data on consecutively admitted patients from a single high-volume stroke center. Patients over 18 years old diagnosed with ICH between 2008-2015 were included. A positive or negative VAN score was determined for all patients via abstraction from the NIHSS score. Demographics, clinical characteristics, and short-term outcomes were compared between VAN+ and VAN- patients. Results: Of the 201 patients included, 176 (87.56%) were VAN+. Patients in the VAN+ group were more frequently black (73.9% vs. 51.9%, p=0.003) and had lower median GCS (11 vs. 15, <0.001) scores upon arrival. Patient in the VAN+ group had a higher frequency of baseline intraventricular hemorrhage (50.0% vs. 30.8%, p=0.01) and a higher median ICH volume (19 vs. 1, p<0.001) compared to VAN- patients. Additionally, VAN+ patients had higher median modified Rankin Scale scores on discharge (5 vs. 3, p<0.001) and longer median lengths of stay (8 vs. 5, p=0.01). Discussion: VAN can identify neurosurgical ICH patients who have more severe presentations with larger hemorrhages with higher frequency of intraventricular hemorrhage. VAN positive ICH patients have longer lengths of stay and worse early functional outcomes. Ascertainment of VAN in the pre-hospital setting can facilitate initial destination of ICH patients to advanced stroke centers with access to neurosurgical expertise.