Revalidation of the RACE scale after its regional implementation in Catalonia: a triage tool for large vessel occlusion.

Aged Aged, 80 and over Area Under Curve Brain Ischemia / diagnosis Cerebrovascular Disorders / diagnosis Emergency Medical Services / methods Female Humans Male Middle Aged Prospective Studies Registries / standards Reproducibility of Results Severity of Illness Index Spain / epidemiology Stroke / diagnosis Triage / methods

stroke thrombectomy thrombolysis

Journal

Journal of neurointerventional surgery

ISSN: 1759-8486

Titre abrégé: J Neurointerv Surg

Pays: England

ID NLM: 101517079

Informations de publication

Date de publication:
Aug 2019

Historique:

received: 19 10 2018

revised: 27 11 2018

accepted: 29 11 2018

pubmed: 24 12 2018

medline: 31 10 2019

entrez: 24 12 2018

Statut: ppublish

Résumé

Our aim was to revalidate the RACE scale, a prehospital tool that aims to identify patients with large vessel occlusion (LVO), after its region-wide implementation in Catalonia, and to analyze geographical differences in access to endovascular treatment (EVT). We used data from the prospective CICAT registry (Stroke Code Catalan registry) that includes all stroke code activations. The RACE score evaluated by emergency medical services, time metrics, final diagnosis, presence of LVO, and type of revascularization treatment were registered. Sensitivity, specificity, and area under the curve (AUC) for the RACE cut-off value ≥5 for identification of both LVO and eligibility for EVT were calculated. We compared the rate of EVT and time to EVT of patients transferred from referral centers compared with those directly presenting to comprehensive stroke centers (CSC). The RACE scale was evaluated in the field in 1822 patients, showing a strong correlation with the subsequent in-hospital evaluation of the National Institute of Health Stroke Scale evaluated at hospital (r=0.74, P<0.001). A RACE score ≥5 detected LVO with a sensitivity 0.84 and specificity 0.60 (AUC 0.77). Patients with RACE ≥5 harbored a LVO and received EVT more frequently than RACE <5 patients (LVO 35% vs 6%; EVT 20% vs 6%; all P<0.001). Direct admission at a CSC was independently associated with higher odds of receiving EVT compared with admission at a referral center (OR 2.40; 95% CI 1.66 to 3.46), and symtoms onset to groin puncture was 133 min shorter. This large validation study confirms RACE accuracy to identify stroke patients eligible for EVT, and provides evidence of geographical imbalances in the access to EVT to the detriment of patients located in remote areas.

Sections du résumé

BACKGROUND AND PURPOSE OBJECTIVE

METHODS METHODS

We used data from the prospective CICAT registry (Stroke Code Catalan registry) that includes all stroke code activations. The RACE score evaluated by emergency medical services, time metrics, final diagnosis, presence of LVO, and type of revascularization treatment were registered. Sensitivity, specificity, and area under the curve (AUC) for the RACE cut-off value ≥5 for identification of both LVO and eligibility for EVT were calculated. We compared the rate of EVT and time to EVT of patients transferred from referral centers compared with those directly presenting to comprehensive stroke centers (CSC).

RESULTS RESULTS

The RACE scale was evaluated in the field in 1822 patients, showing a strong correlation with the subsequent in-hospital evaluation of the National Institute of Health Stroke Scale evaluated at hospital (r=0.74, P<0.001). A RACE score ≥5 detected LVO with a sensitivity 0.84 and specificity 0.60 (AUC 0.77). Patients with RACE ≥5 harbored a LVO and received EVT more frequently than RACE <5 patients (LVO 35% vs 6%; EVT 20% vs 6%; all P<0.001). Direct admission at a CSC was independently associated with higher odds of receiving EVT compared with admission at a referral center (OR 2.40; 95% CI 1.66 to 3.46), and symtoms onset to groin puncture was 133 min shorter.

CONCLUSIONS CONCLUSIONS

This large validation study confirms RACE accuracy to identify stroke patients eligible for EVT, and provides evidence of geographical imbalances in the access to EVT to the detriment of patients located in remote areas.

Identifiants

DOI: 10.1136/neurintsurg-2018-014519 PMID: 30580284

pubmed: 30580284

pii: neurintsurg-2018-014519

doi: 10.1136/neurintsurg-2018-014519

doi:

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

Pagination

751-756

Investigateurs

Tudor Jovin (T)

Informations de copyright

Déclaration de conflit d'intérêts

Competing interests: Not required.