Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Alborz University of Medical Sciences, Karaj, Iran.
BMC Emerg Med. 2023 May 24;23(1):51. doi: 10.1186/s12873-023-00825-7.
It seems that the available data on performance of the Rapid Arterial oCclusion Evaluation (RACE) as a prehospital stroke scale for differentiating all AIS cases, not only large vessel occlusion (LVO), from the stroke mimics is lacking. As a result, we intend to evaluate the accuracy of the RACE criteria in diagnosing of AIS in patients transferred to the emergency department (ED).
The present study was a diagnostic accuracy cross-sectional study during 2021 in Iran. The study population consist of all suspected acute ischemic stroke (AIS) patients who transferred to the ED by emergency medical services (EMS). A 3-part checklist consisting of the basic and demographic information of the patients, items related to the RACE scale, and the final diagnosis of the patients based on interpretation of patients' brain MRI was used for data collection. All data were entered in Stata 14 software. We used the ROC analysis to evaluate the diagnostic power of the test.
In this study, data from 805 patients with the mean age of 66.9 ± 13.9 years were studied of whom 57.5% were males. Of all the patients suspected of stroke who transferred to the ED, 562 (69.8%) had a definite final diagnosis of AIS. The sensitivity and specificity of the RACE scale for the recommended cut-off point (score ≥ 5) were 50.18% and 92.18%, respectively. According to the Youden J index, the best cut-off point for this tool for differentiating AIS cases was a score > 2, at which sensitivity and specificity were 74.73% and 87.65%, respectively.
It seems that, the RACE scale is an accurate diagnostic tool to detect and screen AIS patients in ED, Of course, not at the previously suggested cut-off point (score ≥ 5), but at the score > 2.
似乎目前尚缺乏有关快速动脉闭塞评估（RACE）作为一种院前卒中量表，用于区分所有急性缺血性卒中（AIS）病例，而不仅仅是大血管闭塞（LVO）与卒中模拟病例的相关数据。因此，我们旨在评估 RACE 标准在诊断由紧急医疗服务（EMS）转至急诊科（ED）的 AIS 患者中的准确性。
本研究是 2021 年在伊朗进行的一项诊断准确性横断面研究。研究人群包括所有由 EMS 转至 ED 的疑似急性缺血性卒中（AIS）患者。使用由患者基本和人口统计学信息、与 RACE 量表相关的项目以及根据患者脑部 MRI 解读的最终诊断组成的 3 部分检查表来收集数据。所有数据均输入 Stata 14 软件。我们使用 ROC 分析来评估该检验的诊断效能。
本研究共纳入了 805 例平均年龄为 66.9±13.9 岁的患者，其中 57.5%为男性。所有转至 ED 的疑似卒中患者中，562 例（69.8%）有明确的最终 AIS 诊断。RACE 量表的推荐截断点（评分≥5）的敏感性和特异性分别为 50.18%和 92.18%。根据 Youden J 指数，该工具区分 AIS 病例的最佳截断点为评分>2，此时敏感性和特异性分别为 74.73%和 87.65%。
RACE 量表似乎是一种准确的诊断工具，可用于在 ED 中检测和筛查 AIS 患者，但不是以前建议的截断点（评分≥5），而是评分>2。
