RT Journal Article
SR Electronic
T1 Revalidation of the RACE scale after its regional implementation in Catalonia: a triage tool for large vessel occlusion
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 751
OP 756
DO 10.1136/neurintsurg-2018-014519
VO 11
IS 8
A1 David Carrera
A1 Montse Gorchs
A1 Marisol Querol
A1 Sònia Abilleira
A1 Marc Ribó
A1 Mònica Millán
A1 Anna Ramos
A1 Pedro Cardona
A1 Xabier Urra
A1 Ana Rodríguez-Campello
A1 Luis Prats-Sánchez
A1 Francisco Purroy
A1 Joaquín Serena
A1 David Cánovas
A1 Josep Zaragoza-Brunet
A1 Jerzy A Krupinski
A1 Xavier Ustrell
A1 Júlia Saura
A1 Sonia García
A1 Maria Àngela Mora
A1 Xavier Jiménez
A1 Antoni Dávalos
A1 Natalia Pérez de la Ossa
A1 ,
YR 2019
UL http://jnis.bmj.com/content/11/8/751.abstract
AB Background and purpose 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).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 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 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.