Revalidation of the RACE scale after its regional implementation in Catalonia: a triage tool for large vessel occlusion.

Autor:	Carrera D; Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain., Gorchs M; Emergency Medical Services of Catalonia, Barcelona, Spain., Querol M; Hospital de Mataró, Barcelona, Spain., Abilleira S; Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain., Ribó M; Hospital Vall d'Hebron, Barcelona, Spain., Millán M; Hospital Germans Trias i Pujol, Badalona, Spain., Ramos A; Hospital Germans Trias i Pujol, Badalona, Spain., Cardona P; Hospital Bellvitge, Badalona, Spain., Urra X; Hospital Clínic, Barcelona, Barcelona, Spain., Rodríguez-Campello A; Hospital del Mar, Barcelona, Spain., Prats-Sánchez L; Hospital Santa Creu i Sant Pau, Barcelona, Spain., Purroy F; Hospital Arnau de Vilanova, Lleida, Spain., Serena J; Hospital Josep Trueta, Girona, Spain., Cánovas D; Hospital Parc Taulí, Sabadel, Spain., Zaragoza-Brunet J; Hospital Verge de la Cinta, Tortosa, Spain., Krupinski JA; Hospital Terrassa, Terrassa, Spain., Ustrell X; Hospital Joan XXIII, Tarragona, Spain., Saura J; Hospital Althaia, Manresa, Spain., García S; Hospital Moisés Broggi, Barcelona, Spain., Mora MÀ; Emergency Medical Services of Catalonia, Barcelona, Spain., Jiménez X; Emergency Medical Services of Catalonia, Barcelona, Spain., Dávalos A; Hospital Germans Trias i Pujol, Badalona, Spain., Pérez de la Ossa N; Hospital Germans Trias i Pujol, Badalona, Spain.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2019 Aug; Vol. 11 (8), pp. 751-756. Date of Electronic Publication: 2018 Dec 22.
DOI:	10.1136/neurintsurg-2018-014519
Abstrakt:	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. Competing Interests: Competing interests: Not required. (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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