Objective:

To determine if a novel weighted scoring of FANG-D scale increases sensitivity and specificity rates of large vessel occlusion (LVO) as compared to those with original FANG-D scale scoring. 

Background:

Scales have been developed to detect the severity of strokes based on symptomology. The FANG-D was created and can be completed in one minute. Results from a 2020 study lacked high specificity results. Upon review, it was determined that the severity of symptoms needed to be considered before awarding points indicating positive FANG-D.

Design/Methods:

An observational, descriptive design was used to identify field cut, aphasia, neglect, gaze preference, and dense hemiparesis in patients admitted to the ED of a comprehensive stroke center from December 2022 through April 2023. The NIHSS was compared with the novel weighted FANG-D scale scoring for analysis. Each component was required to have a score ≥ 2 (moderate to severe deficits) except dense hemiparesis which required a score ≥3 (significant weakness) to receive one point on the FANG-D scale. A total score of 2 or higher on FANG-D indicated a positive result suggesting LVO. If aphasia or neglect were present with a NIHSS of ≥2, it was considered a positive FANG-D score.  

Results:

311 patients were included. The sensitivity and specificity rates were 85.7% and 90.5% respectively for positive FANG-D to identify LVO. The previous FANG-D study group used lower values in calculating the FANG-D scores and reported a sensitivity rate of 98% and specificity of 76.7%. 

Conclusions:

The novel weighted FANG-D has high specificity and is reliable for LVO prediction. This scale scoring method could be tested in the prehospital setting. The use of a scale with higher specificity for LVO could improve patient outcomes and resource utilization by faster routing of patients to CSCs capable of performing mechanical thrombectomy.