Introduction Pre-hospital identification of large vessel occlusions (AIS-LVO) has proven to be successful in interhospital transfers and triaging.

Aim of Study This study compares 8 stroke screening scales to detect anterior and posterior circulation AIS-LVO and AIS secondary to medium vessel occlusions (AIS-MeVO).

Methods We analyzed stroke alerts at a stroke center from January 2022 to December 2023. We prospectively applied 8 stroke screening scales (BE-FAST, LAMS, PASS, FAST-ED, EMS RACE, 3-ISS, VAN, and NIHSS) to each stroke alert in the ED and inpatient settings. The final diagnosis for each was classified as AIS-LVO or AIS-MeVO, AIS without LVO or MeVO, intracranial hemorrhage, TIA, and stroke mimic..

Results Of 221 patients where stroke screening scales were performed, 199 patients were analyzed to compare performance of 8 scales in detection of anterior circulation AIS-LVO and AIS-MeVO. The mean age was 63.8 ± 15.2 years, 62.3% were female (n=124), and 84.4% were Black (n=168). The LAMS scale had a strong performance (AUC: 0.750 [95% CI: 0.668-0.831]), followed by the FAST-ED (AUC: 0.736 [95% CI: 0.649-0.822]), and VAN (AUC: 0.735 [95% CI: 0.651-0.818]) scales. Cutoff points selected from coordinates of the ROC curves were 3, 3, and a positive VAN, respectively.

Conclusion This is the first, prospective cohort study comparing the discrimination of 8 different screening scales among stroke alerts in the ED and inpatient settings for the detection of both AIS-LVO and AIS-MeVO. We found LAMS to be the most discriminative for detection of AIS-LVO and AIS-MeVO, followed by FAST-ED and VAN.