目的 探讨并比较视觉-失语-忽视评估（VAN）与美国国立卫生研究院卒中量表（NIHSS）评分在急诊科环境下对急性大血管闭塞（LVO）缺血性脑卒中的早期识别效能。 方法 回顾性分析2023年1月至2024年3月在武汉市第一医院就诊的189例急性缺血性卒中患者的临床资料，所有患者由两名经过培训的急诊医师（主治医师及以上职称）根据急诊病历记录，在未知晓血管影像结果的情况下，独立、回溯性地完成VAN与NIHSS评分，若评估不一致，则经协商达成共识。以头颈CTA或MRA作为诊断LVO的金标准，采用多因素logistic回归分析LVO发生的独立危险因素，通过受试者工作特征曲线（ROC）评估两种评分方式对LVO的诊断评估效能。 结果 纳入189例急性缺血性卒中患者，经金标准（CTA/MRA）检测确诊大血管闭塞91例（48.15%），其中，前循环LVO者59例（64.84%），后循环LVO者32例（35.16%）；多因素logistic回归分析显示，在校正了年龄、心房颤动等混杂因素后，VAN评分阳性（OR = 12.541，95%CI：4.800 ~ 32.766，P < 0.05）与NIHSS评分（OR = 1.319，95%CI：1.115 ~ 1.561，P < 0.05）均为LVO的独立危险因素；ROC曲线分析显示，NIHSS评分诊断LVO的曲线下面积为0.863（95%CI：0.805 ~ 0.921），以最佳截断值10分为标准时，其敏感度为82.42%，特异度为87.76%，阳性预测值为86.21%，阴性预测值为84.31%；VAN评分诊断LVO的曲线下面积为0.857（95%CI：0.799 ~ 0.915），敏感度为84.62%，特异度为86.73%，阳性预测值为85.56%，阴性预测值为85.86%，经DeLong检验，二者曲线下面积比较，差异无统计学意义（Z = 0.166，P > 0.05）；对于前循环LVO，VAN评分的诊断效能（AUC = 0.851，95%CI：0.795 ~ 0.908）高于NIHSS评分的诊断效能（AUC = 0.760，95%CI：0.682 ~ 0.839），差异有统计学意义（Z = 2.013，P < 0.05）；对于后循环LVO，NIHSS评分的诊断效能（AUC = 0.839，95%CI：0.766 ~ 0.912）显著高于VAN评分（AUC = 0.618，95%CI：0.512 ~ 0.724），差异有统计学意义（Z = 3.814，P < 0.001）。 结论 VAN与NIHSS评分均为LVO发生的独立危险因素，可有效评估急性LVO缺血性脑卒中的发生，且VAN评分对前循环LVO的识别效能更优，而NIHSS评分对后循环LVO的识别效能更佳。

Objective To explore and compare the efficiency of early identification of acute large vessel occlusion （LVO） ischemic stroke in the emergency department using the Vision， Aphasia， Neglect （VAN） assessment and the National Institutes of Health Stroke Scale （NIHSS） score. Methods A retrospective analysis was conducted on the clinical data of 189 patients with acute ischemic stroke who received treatment in the emergency department of the hospital from January 2023 to March 2024. The VAN and NIHSS scores were determined by trained emergency physicians upon admission. Two trained emergency physicians （with a title of attending physician or above） independently and retrospectively scored all patients based on emergency medical records without being aware of the vascular imaging results. In case of inconsistent evaluations， a consensus was reached through consultation. Using head-neck CTA or MRA as the gold standard for LVO diagnosis， the independent predictors of LVO were analyzed via multivariate logistic regression analysis， and the diagnostic efficiency of the two scoring methods for LVO was assessed by receiver operating characteristic （ROC） curves. Results Among the 189 patients with acute ischemic stroke， the gold-standard method （CTA/MRA） indicated that 91 cases （48.15%） had LVO， including 59 cases （64.84%） with anterior circulation LVO and 32 cases （35.16%） with posterior circulation LVO. Multivariate logistic regression analysis revealed that after adjusting for confounding factors such as age and atrial fibrillation， a positive VAN （OR = 12.541， 95%CI： 4.800 ~ 32.766， P < 0.05） and the NIHSS score （OR = 1.319， 95%CI： 1.115 ~ 1.561， P < 0.05） were both independent predictors of LVO. ROC curve analysis demonstrated that the area under the curve （AUC） of the NIHSS score for the diagnosis of LVO was 0.863 （95%CI： 0.805 ~ 0.921）. Using the optimal cut-off value （10 points） as the criterion， its sensitivity， specificity， positive predictive value， and negative predictive value were 82.42%， 87.76%， 86.21%， and 84.31%， respectively. The AUC， sensitivity， specificity， positive predictive value， and negative predictive value of VAN for the diagnosis of LVO were 0.857 （95%CI： 0.799 ~ 0.915）， 84.62%， 86.73%， 85.56%， and 85.86%， respectively. The DeLong test showed that there was no significant difference in the AUC between the two scoring methods （Z = 0.166， P = 0.869）. Regarding anterior circulation LVO， the diagnostic efficiency of VAN was higher than that of the NIHSS score ［（AUC = 0.851， 95%CI： 0.795 ~ 0.908） vs. （AUC = 0.760， 95%CI： 0.682 ~ 0.839）， Z = 2.013， P = 0.044］. For posterior circulation LVO， the diagnostic efficiency of the NIHSS score was significantly higher than that of VAN ［（AUC = 0.839， 95%CI： 0.766 ~ 0.912） vs. （AUC = 0.618， 95%CI： 0.512 ~ 0.724）， Z = 3.814， P < 0.001］. Conclusions Both the VAN and NIHSS score are independent predictors of LVO， which can effectively assess the occurrence of acute LVO ischemic stroke. Furthermore， the VAN demonstrates superior identification efficiency for anterior circulation LVO， whereas the NIHSS score exhibits better identification efficiency for posterior circulation LVO.