Abstract Details

Title Triage of Acute Strokes Using an EMS-driven Rapid Arterial Occlusion Evaluation (RACE) Protocol: a Longitudinal Study.

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-044

Objective To see if faster triaging in the field using RACE, leads to improved re-vascularization times, better 90-day outcomes and mortality.

Background Successful implementation of an EMS-driven bypass protocol, Rapid Arterial occlusion Evaluation (RACE) score, for triage of acute strokes was previously published in 2017. Here, we describe the long-term results of our RACE alert protocol.

Design/Methods Patients with a RACE score >5, who are last seen normal within 12 hours, wake up with stroke symptoms, or have unknown time of symptoms onset were directly transferred as RACE alerts (RA) to our two stroke centers (one primary with interventional capabilities and one comprehensive) with interventional capacity in Lucas County, Ohio. Data including baseline demographics, RACE score, diagnosis, treatments and procedures, and clinical and angiographic outcomes were captured in a prospective database.

Results From July 2015 to July 2018, 511 RAs were triaged. Median age of RA patients was 73 (IQR 63-82), 55.8% were female, and median RACE score was 7 (IQR 5-8). Median time from 911 dispatch to ER was 31 minutes (IQR 22-38) and onset to arrival was 85 minutes (IQR 47-307). Of the 511 RAs, 52.3% were diagnosed with an ischemic stroke, 13.5% intracerebral hemorrhage, 6.5% transient ischemic attack, 12.9% seizure, and 7.8% encephalopathy. The rate of IV-tPA use was 24.5% and median door to needle time was 33 min (IQR 24-48). The rate of mechanical thrombectomy (MT) was 24.3%, with median door to puncture and door to revascularization times of 64 (IQR 48.5-78.5) and 91 minutes (IQR 79.3-114.8), respectively. The majority of occlusions were MCA (73.2%). Successful revascularization (TICI≥2b) was achieved in 84.7%. Ninety-day favorable outcome (mRS 0-2) and mortality was 47.2% and 25.4% in patients who underwent MT.

Conclusions Our results show the long-term feasibility and efficiency of an EMS-driven early stroke triage protocol using the RACE score.

Authors/Disclosures
Ehad Afreen, MD (Promedica Physicians Group Neurology) PRESENTER	Dr. Afreen has nothing to disclose.
Alicia C. Castonguay, PhD	Dr. Castonguay has nothing to disclose.
Syed F. Zaidi, MD (ProMedica Stroke Network)	Dr. Zaidi has nothing to disclose.
Mouhammad A. Jumaa, MD (ProMedica Stroke Network)	Dr. Jumaa has nothing to disclose.
Nurose Karim, MD (ECU Health Medical Center)	Dr. Karim has nothing to disclose.
Giana Dawod, MD (NYP/Cornell)	Ms. Dawod has nothing to disclose.
Nicholas D. Henkel	No disclosure on file
Hisham Salahuddin, MD	Dr. Salahuddin has nothing to disclose.
Julie Shawver (Promedica Physicians Group)	No disclosure on file
	No disclosure on file

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