Challenges Related to the Implementation of an EMS-Administered, Large Vessel Occlusion Stroke Score

Overview

Journal West J Emerg Med

Specialty Emergency Medicine

Date 2020 Mar 20

PMID 32191202

Citations 4

Authors

Benjamin J Lawner

Kelly Szabo

Jonathan Daly

Krista Foster

Philip McCoy

David Poliner

Matthew Poremba

Philip S Nawrocki

Rahul Rahangdale

Affiliations

Soon will be listed here.

Abstract

Introduction: There is considerable interest in triaging victims of large vessel occlusion (LVO) strokes to comprehensive stroke centers. Timely access to interventional therapy has been linked to improved stroke outcomes. Accurate triage depends upon the use of a validated screening tool in addition to several emergency medical system (EMS)-specific factors. This study examines the integration of a modified Rapid Arterial oCcclusion Evaluation (mRACE) score into an existing stroke treatment protocol.

Methods: We performed a retrospective review of EMS and hospital charts of patients transported to a single comprehensive stroke center. Adult patients with an EMS provider impression of "stroke/TIA," "CVA," or "neurological problem" were included for analysis. EMS protocols mandated the use of the Cincinnati Prehospital Stroke Score (CPSS). The novel protocol authorized the use of the mRACE score to identify candidates for triage directly to the comprehensive stroke center. We calculated specificity and sensitivity for various stroke screens (CPSS and a mRACE exam) for the detection of LVO stroke. The score's metrics were evaluated as a surrogate marker for a successful EMS triage protocol.

Results: We included 312 prehospital charts in the final analysis. The CPSS score exhibited reliable sensitivity at 85%. Specificity of CPSS for an LVO was calculated at 73%. For an mRACE score of five or greater, the sensitivity was 25%. Specificity for mRACE was calculated at 75%. The positive predictive value of the mRACE score for an LVO was estimated at 12.50%.

Conclusion: In this retrospective study of patients triaged to a single comprehensive stroke center, the addition of an LVO-specific screening tool failed to improve accuracy. Reliable triage of LVO strokes in the prehospital setting is a challenging task. In addition to statistical performance of a particular stroke score, a successful EMS protocol should consider system-based factors such as provider education and training. Study limitations can inform future iterations of LVO triage protocols.

Citing Articles

Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early Identification of Cerebral Large Vessel Occlusions; a Systematic Review and Meta-analysis.

Baser Y, Zarei H, Gharin P, Baradaran H, Sarveazad A, Dizaji S Arch Acad Emerg Med. 2024; 12(1):e38.

PMID: 38737135 PMC: 11088790. DOI: 10.22037/aaem.v12i1.2242.

Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review.

Nicholls J, Ince J, Minhas J, Chung E Front Neurol. 2022; 12:780324.

PMID: 35095726 PMC: 8796731. DOI: 10.3389/fneur.2021.780324.

Emergency medical dispatchers' ability to identify large vessel occlusion stroke during emergency calls.

Vuorinen P, Ollikainen J, Ketola P, Vuorinen R, Setala P, Hoppu S Scand J Trauma Resusc Emerg Med. 2021; 29(1):97.

PMID: 34281596 PMC: 8287663. DOI: 10.1186/s13049-021-00914-1.

[Comparison of RACE scale to other assessment scales for large vessel arterial occlusions in the out-of-hospital level: a rapid review].

Senovilla-Gonzalez L, Hernandez-Ruiz A, Garcia-Garcia M An Sist Sanit Navar. 2021; 44(2):275-289.

PMID: 34170888 PMC: 10019551. DOI: 10.23938/ASSN.0964.

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