Abstract
ABSTRACTBackgroundThe Rapid Arterial oCclusion Evaluation (RACE) score can identify patients with anterior circulation large vessel occlusion (aLVO) ischemic stroke for transportation to a comprehensive stroke center for endovascular thrombectomy. However, patients with intracranial hemorrhage (ICH) may also benefit from direct transportation to a comprehensive stroke center for neurosurgical treatment. We aimed to assess if the RACE score can distinguish patients with ICH in addition to aLVO stroke from other suspected stroke patients.MethodsWe analyzed data from the Leiden Prehospital Stroke Study: a multicenter, prospective, observational cohort study in two Dutch ambulance regions. Ambulance paramedics documented prehospital observations in all patients ≥18 years with suspected stroke. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a positive RACE score (≥5 points) for a diagnosis of ICH or aLVO stroke, compared to patients with non-aLVO stroke, TIA, or stroke mimic. Additionally, we performed a multivariable logistic regression analysis and calculated adjusted odds ratios (aOR).ResultsWe included 2004 stroke code patients, of whom 149 had an ICH, 153 an aLVO stroke, 687 a non-aLVO stroke, 262 a TIA and 753 a stroke mimic. Patients with ICH and aLVO stroke more often had a positive RACE score than other suspected stroke patients (respectively 46.2% and 58.0% vs. 6.4%, p<0.01). A positive RACE score had a sensitivity of 52.7%, specificity of 93.6%, PPV of 55.4% and NPV of 92.9% for a diagnosis of ICH or aLVO stroke. In multivariable analysis, a positive RACE score had the strongest association with ICH or aLVO stroke (aOR 10.11, 95% CI 6.84-14.93).Conclusions and RelevanceOur study shows that the RACE score can also identify patients with ICH in addition to aLVO stroke. This emphasizes the potential of the RACE for improving prehospital triage and allocation of stroke patients.
Publisher
Cold Spring Harbor Laboratory