Prehosp Emerg Care. 2019 Sep-Oct;23(5):612-618. doi: 10.1080/10903127.2019.1573281. Epub 2019 Feb 20.
: Emergency Medical Services (EMS) providers may identify and preferentially transport patients experiencing large vessel occlusion (LVO) stroke to appropriate treatment centers. The Rapid Arterial oCclusion Evaluation (RACE) scale was created for prehospital LVO detection, yet few studies have evaluated its function in real-world EMS settings. Our objective was to assess the prehospital performance of the RACE scale for detecting LVO stroke following implementation at a large suburban/rural agency in the United States. : In this retrospective analysis, all 9-1-1 patients with an EMS provider primary or secondary impression of stroke treated by the agency between June 1, 2016 and November 1, 2017 were eligible for inclusion. Patient data were abstracted using a standardized form completed by receiving hospitals. Performance for LVO detection at each RACE cutoff value was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the RACE scale overall. A secondary analysis of RACE for patients experiencing strokes best treated at comprehensive stroke centers (LVO and intracerebral hemorrhage [ICH]) was conducted. : There were 440 patients with a documented RACE score and hospital outcome data included in the analysis. About half (51%, = 220) were female and the median age was 70 years (IQR: 59-81). Last known well time was under 4.5 hours for 76% of patients ( = 261). Over half (61%, = 269) had a hospital discharge diagnosis of stroke and 64/440 (15%) were classified as LVO. The ROC curve demonstrated adequate discrimination with a c-statistic of 0.72. Performance for identifying LVO in the prehospital setting was greatest for RACE scores ≥5 with a sensitivity of 66% and specificity of 72%, PPV of 29%, and NPV of 93%. A RACE score ≥5 for both LVO and ICH demonstrated sensitivity: 63%, specificity: 77%, PPV: 47% and NPV: 86%. : The RACE scale demonstrated acceptable discrimination, yet the sensitivity and positive predictive value were lower in this cohort of EMS professionals in the United States than in the original validation study conducted in Spain. Further work is needed to determine the optimal prehospital screening tool for identification of LVO.
: 急救医疗服务（EMS）提供者可以识别并优先将经历大血管闭塞（LVO）中风的患者转运至合适的治疗中心。RACE 量表是为院前 LVO 检测而创建的，但很少有研究评估其在现实世界 EMS 环境中的功能。我们的目的是评估在美国一家大型郊区/农村机构实施后，RACE 量表在检测 LVO 中风方面的院前表现。 : 在这项回顾性分析中，所有 2016 年 6 月 1 日至 2017 年 11 月 1 日期间由该机构治疗的有 EMS 提供者主要或次要中风印象的 9-1-1 患者均有资格纳入。使用由接收医院完成的标准化表格提取患者数据。使用灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）评估每个 RACE 截止值的 LVO 检测性能。使用接收者操作特征（ROC）曲线评估 RACE 量表的整体判别能力。对最适合在综合中风中心治疗的中风患者（LVO 和颅内出血 [ICH]）的 RACE 进行了二次分析。 : 有 440 名患者记录了 RACE 评分和医院结果数据，包括在分析中。大约一半（51%，=220）为女性，中位年龄为 70 岁（IQR：59-81）。76%的患者（=261）最后一次了解自己的情况时间不到 4.5 小时。超过一半（61%，=269）出院诊断为中风，440 例中有 64 例（15%）被归类为 LVO。ROC 曲线显示出适度的判别能力，c 统计量为 0.72。在院前环境中识别 LVO 的表现最佳的是 RACE 评分≥5，灵敏度为 66%，特异性为 72%，PPV 为 29%，NPV 为 93%。RACE 评分≥5 对 LVO 和 ICH 的敏感性分别为 63%、特异性为 77%、PPV 为 47%和 NPV 为 86%。 : RACE 量表显示出可接受的判别能力，但在美国的 EMS 专业人员中，该量表的敏感性和阳性预测值均低于最初在西班牙进行的验证研究。需要进一步研究确定用于识别 LVO 的最佳院前筛选工具。
