Evaluating the use of vision-face-arm-speech-time in stroke admissions: A comparative study with national institutes of health stroke scale and orthoptist assessment in an emergency department

ObjectivesVisual problems are common in acute stroke, however no standardised vision screening tool is routinely used in pre-hospital or emergency department settings. This study evaluated the V-FAST (vision-face-arm-speech-time) checklist for detecting visual impairment in patients admitted with suspected stroke.DesignProspective, service evaluation study.SettingOne emergency department.ParticipantsAbout 282 consecutive patients with suspected stroke.Main measuresAll patients were assessed with the National Institutes of Health Stroke Scale, V-FAST checklist, and reference standard orthoptic assessment. Main outcomes included visual impairment detection rates and diagnostic performance (sensitivity, specificity, predictive values, and agreement).ResultsOf 282 screened patients (mean (SD) age 73 (11) years; 51.5% females), 158 (56.2%) had stroke confirmed. Among these, visual impairment was detected in 64.0% by orthoptists, 34.0% by the National Institutes of Health Stroke Scale (κ = 0.22), and 47.0% by V-FAST (κ=0.34). In FAST-positive strokes, National Institutes of Health Stroke Scale and V-FAST detected visual impairment in 83.3% and 76.0%, respectively; in FAST-negative strokes, detection was 16.7% and 24.0%, respectively, compared to orthoptic assessments. V-FAST showed better diagnostic performance than National Institutes of Health Stroke Scale, with sensitivity, specificity, positive/negative predictive values and kappa of 78.7%, 97.2%, 83.6%, 90.0%, and 0.79, respectively.ConclusionThe V-FAST checklist demonstrates fair agreement with orthoptist assessment and complements the National Institutes of Health Stroke Scale for detecting visual impairment in stroke admissions in the emergency department, with particular benefit in FAST-negative strokes. These findings support integrating a standardised screening checklist for visual impairment detection into emergency department stroke pathways.