From the University of Glasgow, School of Life Sciences, United Kingdom (E.S.); Queen Elizabeth University Hospital Glasgow, NHS Greater Glasgow and Clyde, United Kingdom (E.S.); Universität Hamburg, Medizinische Fakultät, Germany (E.S.); Department of Neurology (M. Ebinger, C.H.N., M. Endres, L.S.) and Center for Stroke Research Berlin (CSB) (M. Ebinger, C.H.N., M. Endres, L.S.), Charité-Universitätsmedizin, Germany; Department of Neurology, MEDICAL PARK Berlin Humboldtmühle, Germany (M. Ebinger); Berlin Institute of Health (BIH), Germany (C.H.N., M. Endres, L.S.); DZHK (German Center for Cardiovascular Research) (M. Endres) and DZNE (German Center for Neurodegenerative Diseases) (M. Endres), Partner Site, Berlin, Germany; and London School of Economics and Political Science, United Kingdom (L.S.).
Stroke. 2017 Aug;48(8):2184-2191. doi: 10.1161/STROKEAHA.117.017281. Epub 2017 Jun 27.
Patients with acute ischemic stroke (AIS) and large vessel occlusion may benefit from direct transportation to an endovascular capable comprehensive stroke center (mothership approach) as opposed to direct transportation to the nearest stroke unit without endovascular therapy (drip and ship approach). The optimal transport strategy for patients with AIS and unknown vessel status is uncertain. The rapid arterial occlusion evaluation scale (RACE, scores ranging from 0 to 9, with higher scores indicating higher stroke severity) correlates with the National Institutes of Health Stroke Scale and was developed to identify patients with large vessel occlusion in a prehospital setting. We evaluate how the RACE scale can help to inform prehospital triage decisions for AIS patients.
In a model-based approach, we estimate probabilities of good outcome (modified Rankin Scale score of ≤2 at 3 months) as a function of severity of stroke symptoms and transport times for the mothership approach and the drip and ship approach. We use these probabilities to obtain optimal RACE cutoff scores for different transfer time settings and combinations of treatment options (time-based eligibility for secondary transfer under the drip and ship approach, time-based eligibility for thrombolysis at the comprehensive stroke center under the mothership approach).
In our model, patients with AIS are more likely to benefit from direct transportation to the comprehensive stroke center if they have more severe strokes. Values of the optimal RACE cutoff scores range from 0 (mothership for all patients) to >9 (drip and ship for all patients). Shorter transfer times and longer door-to-needle and needle-to-transfer (door out) times are associated with lower optimal RACE cutoff scores.
Use of RACE cutoff scores that take into account transport times to triage AIS patients to the nearest appropriate hospital may lead to improved outcomes. Further studies should examine the feasibility of translation into clinical practice.
急性缺血性脑卒中（AIS）伴大血管闭塞的患者可能受益于直接转运至有血管内治疗能力的综合卒中中心（母舰模式），而不是直接转运至无血管内治疗能力的最近卒中单元（滴注和转运模式）。对于 AIS 且血管状态未知的患者，最佳转运策略尚不确定。快速动脉闭塞评估量表（RACE，评分 0-9 分，分数越高表示卒中越严重）与国立卫生研究院卒中量表相关，旨在识别院前大血管闭塞患者。我们评估 RACE 量表如何有助于为 AIS 患者提供院前分诊决策信息。
我们采用基于模型的方法，根据卒中严重程度和转运时间来估计母舰模式和滴注和转运模式下的良好预后（3 个月时改良 Rankin 量表评分≤2）的概率。我们使用这些概率来获得不同转运时间设置和治疗方案组合（滴注和转运模式下基于时间的二次转运资格，母舰模式下基于时间的溶栓资格）下的最佳 RACE 截断评分。
在我们的模型中，如果 AIS 患者的卒中更严重，那么他们更有可能受益于直接转运至综合卒中中心。最佳 RACE 截断评分的取值范围为 0（所有患者均采用母舰模式）至>9（所有患者均采用滴注和转运模式）。较短的转运时间以及更长的门到针和针到转运（门出）时间与较低的最佳 RACE 截断评分相关。
使用考虑转运时间的 RACE 截断评分来对 AIS 患者进行分诊至最近的合适医院，可能会改善预后。进一步的研究应考察其在临床实践中的可行性。
