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Peer-reviewedCC BY 4.0Clinical Rehabilitation

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

  • Muath Alobaida1,2,3
  • Deirdre A. Lane1,2,4
  • Stephanie L. Harrison1,2,5
  • Gregory Y. H. Lip1,2,4
  • Fiona J. Rowe6
6 affiliations
  1. 1Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
  2. 2Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
  3. 3Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
  4. 4Danish Center for Health Services, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  5. 5Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
  6. 6Institute of Population Health, University of Liverpool, Liverpool, UK
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Abstract

Objectives: Visual 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.

Design: Prospective, service evaluation study.

Setting: One emergency department.

Participants: About 282 consecutive patients with suspected stroke.

Main measures: All 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).

Results: Of 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.

Conclusion: The 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.

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Cite

BibTeXRIS
BibTeX
@article{alobaida2026evaluating,
  title = {{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}},
  author = {Muath Alobaida and Deirdre A. Lane and Stephanie L. Harrison and Gregory Y. H. Lip and Fiona J. Rowe},
  journal = {Clinical Rehabilitation},
  year = {2026},
  month = may,
  doi = {10.1177/02692155261450137},
  url = {https://doi.org/10.1177/02692155261450137},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - 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
AU  - Muath Alobaida
AU  - Deirdre A. Lane
AU  - Stephanie L. Harrison
AU  - Gregory Y. H. Lip
AU  - Fiona J. Rowe
PY  - 2026
DA  - 2026/05/14
JO  - Clinical Rehabilitation
DO  - 10.1177/02692155261450137
UR  - https://doi.org/10.1177/02692155261450137
AB  - Objectives: Visual 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.  Design: Prospective, service evaluation study.  Setting: One emergency department.  Participants: About 282 consecutive patients with suspected stroke.  Main measures: All 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).  Results: Of 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.  Conclusion: The 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.
SN  - 0269-2155
SN  - 1477-0873
ER  -