Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by Neurological History and Examination

Abstract

Background and Purpose-The Questionnaire for Verifying Stroke-Free Status (QVSFS) is an 8-item structured interview designed to identify stroke-free individuals. Previously, the QVSFS was validated with medical record review in a cohort with a low prevalence (7.1%) of stroke or transient ischemic attack (TIA). The objective of this study was to evaluate the validity of the QVSFS by comparing it with stroke status as determined by neurological history and examination in a population with a higher prevalence of stroke. Methods-A research assistant administered the QVSFS to outpatients from Veterans Administration stroke and general medicine clinics. Subjects were defined as QVSFS negative if responses to all 8 questions were negative. Questions requiring rephrasing or clarification were noted. Neurologists, blinded to QVSFS scores, interviewed and examined all subjects to determine stroke-free status, defined as no history or examination findings of previous stroke and/or TIA. Results-One hundred fifty-five subjects were examined; mean age was 70 years; 98.1% were male. Seventy-eight subjects were determined to be stroke free by the neurologist. The negative predictive value of the QVSFS was 0.96, with positive predictive value of 0.71. No question required rephrasing or clarification Ͼ5 times. Twenty-two subjects (14.2%) required rephrasing or clarification of at least 1 question. Conclusions-The QVSFS can effectively identify stroke-free individuals with a high degree of accuracy, even in a population with a large proportion of patients with prior stroke or TIA. Accuracy for identifying subjects with stroke and/or TIA is lower, but the QVSFS may still be useful as a screening tool in that regard.

Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

“…Living participants or their proxies were followed up every 6 months by telephone, with retrieval of medical records for reported hospitalizations or physician visits. Data were collected on suspected stroke events that required hospitalization and on physician evaluations for stroke‐like symptoms detected using the Questionnaire for Verifying Stroke‐Free Status 17. The adjudication process validated stroke occurrence and classified events by stroke “subtype” and severity using the National Institutes of Health Stroke Scale.…”

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

“…All participants were followed using medical record review and a validated, standardized telephone questionnaire. 13 Potential subsequent strokes identified in follow-up were adjudicated by a panel blinded to the initial presentation, unless the subsequent stroke was diagnosed by the treating neurologist, in which case it was automatically deemed an outcome event.…”

Stroke-free status and depression scores among Saudi dialysis patients

“…We are unable to do the same validation tool in our patients as the effect from terminal renal failure and MRI in this setting would be contraindicated to avoid the development of gadoliniuminduced nephrogenic systemic fibrosis (NSF). 14 Instead of this, we used another method of QVSFS validation previously used 15 which is based on clinical evaluation instead of an imaging evaluation.…”

“…The positive predictive value (PPV), however, was much lower (0.36) 7 This high degree of NPV associated with the QVSFS can be observed even in populations with a high prevalence of prior strokes or TIAs. 8 Depression is a common finding among patients on hemodialysis. In a large DOPPS study carried out in the United States five European countries, the prevalence of depression was found to be 20%.…”