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Performance of the RACE Prehospital Triage Score During Working and Nonworking Hours.

Hisham Salahuddin1,2,3, Alicia C Castonguay1,2, Emi Hitomi2

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The Rapid Arterial Occlusion Evaluation (RACE) score effectively identifies large vessel occlusions (LVOs) 24/7. It is more accurate for detecting acute neurovascular syndromes during nonworking hours due to fewer stroke mimics.

Keywords:
acute ischemic strokelarge vessel occlusionprehospitalthrombectomytriage

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Stroke Research

Background:

  • Prehospital triage scores are crucial for identifying large vessel occlusions (LVOs) in emergency settings.
  • The real-world accuracy of these scores over a 24-hour period, including nonworking hours, is not well-established.
  • The Rapid Arterial Occlusion Evaluation (RACE) score is a key tool for prehospital LVO detection.

Purpose of the Study:

  • To compare the positive predictive value (PPV) of the RACE score for LVO detection during working versus nonworking hours.
  • To evaluate the RACE score's accuracy in identifying acute neurovascular syndromes and its impact on treatment times and outcomes.

Main Methods:

  • Retrospective review of 687 patients with a RACE score ≥5 across two hospitals (July 2015-December 2019).
  • Patients were categorized into 'working hours' (weekdays, 7 am-6 pm) and 'nonworking hours' (evenings, nights, weekends).
  • Primary outcome: LVO diagnosis. Secondary outcomes: acute neurovascular syndrome diagnosis, door-to-treatment times, and modified Rankin Scale (mRS) scores.

Main Results:

  • No significant difference in LVO diagnosis rates between working (34.6%) and nonworking hours (36.3%).
  • The RACE score demonstrated improved PPV for acute neurovascular syndromes during nonworking hours (76.3% vs. 67.8%).
  • Good clinical outcomes (mRS ≤2) were similar for mechanical thrombectomy patients, despite shorter treatment times during working hours.

Conclusions:

  • The RACE score maintains consistent accuracy for LVO detection across all hours.
  • Increased accuracy for neurovascular syndromes during nonworking hours is attributed to a reduction in stroke mimics.
  • The findings support the reliable use of the RACE score in prehospital stroke assessment, irrespective of time.