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Design and Interrater Reliability of the Pediatric Version of the Race Scale: PedRACE

Eulàlia Turón-Viñas^1,2,3, Susana Boronat^1,2,3, Ignasi Gich^2,4,5,3

¹Department of Child Neurology, Pediatrics Service, Hospital Sant Pau, Barcelona, Spain (E.T.-V., S.B.).

|July 25, 2024

Insights

The Pediatric RACE scale effectively identifies children with acute stroke, correlating well with existing measures and showing high reliability. This simple tool aids non-neurologists in early detection for timely treatment.

Area of Science:

Pediatric neurology
Emergency medicine
Clinical assessment tools

Background:

Acute ischemic stroke is a major cause of death and disability in children.
Early detection is crucial for effective acute ischemic stroke treatment in pediatric patients.
The adult Rapid Arterial Occlusion Evaluation (RACE) scale demonstrates high sensitivity and specificity for detecting large vessel occlusion.

Purpose of the Study:

To adapt the adult RACE scale for pediatric use, creating the Pediatric RACE scale.
To evaluate the correlation of the Pediatric RACE scale with the Pediatric National Institutes of Health Stroke Scale (NIHSS).
To assess the interrater reliability of the Pediatric RACE scale among prehospital/emergency staff and child neurologists.

Main Methods:

The Pediatric RACE scale was developed by adapting the adult RACE scale.
Prehospital/emergency staff and child neurologists tested the scale on pediatric stroke patients.
Correlation with Pediatric NIHSS and interrater reliability were analyzed.

Main Results:

The Pediatric RACE scale showed strong correlation with the Pediatric NIHSS (Spearman ρ, 0.852; P<0.001 by neurologists; Spearman ρ, 0.781; P<0.001 by prehospital/emergency staff).
High agreement was observed between prehospital/emergency staff and child neurologists (82% overall, 100% for specific items).
The Pediatric RACE scale median score was significantly higher in patients with large vessel occlusion.

Conclusions:

The Pediatric RACE scale demonstrates good interrater reliability and strong correlation with the Pediatric NIHSS.
It is a simple and effective tool for detecting candidates for pediatric acute stroke treatment.
The scale is suitable for use by non-neurologist medical staff in both prehospital and in-hospital settings.

Read full analysis

Abstract

Background:

Acute ischemic stroke is a leading cause of pediatric death and disability. A clinical scale adapted for children can ensure early detection of candidates for urgent acute ischemic stroke treatment. The Rapid Arterial Occlusion Evaluation (RACE) scale for adults, which scores 5 items (facial palsy 0-2; arm motor function 0-2; leg motor function 0-2; head/gaze deviation 0-1; and aphasia or agnosia 0-2), has good sensitivity and specificity in detecting large vessel occlusion.

Methods:

We adapted the previously validated RACE scale for use in children as the Pediatric RACE scale. This adapted scale was tested by prehospital/emergency room staff attending to patients covered by the Catalan Pediatric Stroke Code and child neurologists for its correlation with the Pediatric National Institutes of Health Stroke Scale and for interrater reliability.

Results:

The study included 50 children, 18 with confirmed strokes (7 acute ischemic strokes and 11 hemorrhagic strokes). Prehospital/emergency staff and child neurologists agreed fully regarding 82% of patients and 100% regarding head/gaze deviation and agnosia. The Pediatric RACE scale correlated strongly with the Pediatric National Institutes of Health Stroke Scale in evaluations by child neurologists (Spearman ρ, 0.852; P<0.001) and prehospital/emergency staff (Spearman ρ, 0.781; P<0.001). The median Pediatric RACE score was significantly higher in patients with large vessel occlusion (6.5; interquartile range, 6-7) than with other etiologies.

Conclusions:

Pediatric RACE, showing good interrater reliability and correlation with the Pediatric National Institutes of Health Stroke Scale, is a simple scale to detect candidates for pediatric acute stroke treatment, designed for both prehospital and in-hospital use by non-neurologist medical staff.

Keywords:

child emergency medical services ischemic stroke neurologists stroke

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