Abstract
Background
Rapid arterial occlusion evaluation (RACE) scale is a valid prehospital tool used
to predict large vessel occlusion of major cerebral arteries in patients with suspected
acute stroke. RACE scale administered by Emergency medicine services (EMS) technicians
in the prehospital setting correlates well with NIH Stroke Scale score after patient
arrival at a hospital. Despite this, the RACE scale is often characterized as too
difficult for EMS technicians to accurately utilize. There are no data examining RACE
scale accuracy in the prehospital setting comparing EMS technicians with neurologists.
We sought to examine agreement between RACE scores calculated by EMS technicians and
stroke neurologists in the prehospital setting during telestroke consultation.
Methods
Data for this observational cohort study were prospectively collected and retrospectively
analyzed. EMS technicians in person and stroke specialized neurologists via televideo
connection independently assessed suspected stroke patients and calculated RACE scores
in the prehospital setting. We used a linearly weighted Cohen's kappa (kw) to estimate the extent of agreement for RACE score between EMS technicians and stroke
neurologists.
Results
Thirty-one patients with stroke symptoms were independently examined and assessed
with the RACE scale by EMS technicians and stroke neurologists in the prehospital
setting. Exact agreement on the RACE score was found in 24 of 31 (77%) patients. We
found very good agreement between EMS technicians and stroke neurologists, kw = .818 (95% CI, .677-.960), P< .001.
Conclusions
EMS technicians provide reliable RACE assessments in patients with suspected stroke,
with agreement similar to stroke specialized neurologists in the prehospital setting.
Key Words
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Article info
Publication history
Published online: March 29, 2020
Accepted:
February 4,
2020
Received in revised form:
February 3,
2020
Received:
November 11,
2019
Footnotes
Funding statement: This work was supported by the Verizon Foundation grant number 4284.
Data sharing: Data that support the findings of this study are available from the corresponding author upon reasonable request.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104745
Copyright
© 2020 Elsevier Inc. All rights reserved.
