Abstract Details

Title Challenges with the use of Prehospital Stroke Scales for early identification of Large Vessel Occlusion Strokes.

Topic Practice, Policy, and Ethics

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-068

Objective To examine the implementation of a novel, statewide EMS protocol involving a modified Rapid Arterial oCclusion Evaluation (mRACE) score to increase reliability of prehospital triage.

Background The Pennsylvania Department of Health recently endorsed the mRACE scale to EMS protocol statewide. A challenge associated with prehospital stroke care is the lack of agreement between the prehospital diagnosis and the final clinical diagnosis. Diagnostic uncertainty contributes to the over-triage of patients to comprehensive stroke centers. Increases in patient volume places additional burdens upon specialty care facilities.

Design/Methods We conducted a retrospective review of prehospital charts from November 1^st, 2016 to June 30, 2017. The region’s electronic medical record, emsCharts, identified all calls with a stroke related impression. Charts containing the Cincinnati Prehospital Stroke Scale (CPSS) or mRACE score were further analyzed. The field impression was then compared with the final hospital discharge diagnosis.

Results 313 charts were reviewed. 256 charts utilized CPSS, 29 mRACE, and 28 remaining records used “other” stroke scales. Out of 133 CPSS positive patients, there were 28 false positives for 88% sensitivity [95% CI 81.05-93.42]. Of the 123 negative exams, there were 14 false negatives for 80% specificity. The mRACE scale’s sensitivity for early identification of large vessel occlusion (LVO) strokes was 75% [95% CI 19.41-99.37], and specificity was 16% [95% CI 4.54-36.08].

Conclusions The implementation of a novel, statewide EMS protocol intended to identify and transport patients with suspected LVO strokes performed with less than expected results. The addition of a mRACE score into existing triage protocols to be transported to comprehensive centers performed less reliable than the historically utilized CPSS. Prospectively oriented research is needed to identify characteristics of a reliable, accurate, and easily operationalized EMS triage protocol for LVO strokes, and better qualify the benefits of the mRACE score over more widely used methods.

Authors/Disclosures
Rahul H. Rahangdale, MD PRESENTER	Dr. Rahangdale has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
David T. Poliner, DO (University of Maryland Medical Center)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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