Revalidation of the RACE scale after its regional implementation in Catalonia: a triage tool for large vessel occlusion. Carrera, D., Gorchs, M., Querol, M., Abilleira, S., Ribó, M., Millán, M., Ramos, A., Cardona, P., Urra, X., Rodríguez-Campello, A., Prats-Sánchez, L., Purroy, F., Serena, J., Cánovas, D., Zaragoza-Brunet, J., Krupinski, J. A., Ustrell, X., Saura, J., García, S., Mora, M. À., Jiménez, X., Dávalos, A., Pérez de la Ossa, N., Catalan Stroke Code, & (Cat-SCR), R. C. Journal of Neurointerventional Surgery, December, 2018.
doi  abstract   bibtex   
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\textless0.001). A RACE score ≥5 detected LVO with a sensitivity 0.79 and specificity 0.62 (AUC 0.76). Patients with RACE ≥5 harbored a LVO and received EVT more frequently than RACE \textless5 patients (LVO 35% vs 6%; EVT 20% vs 6%; all P\textless0.001). 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.
@article{carrera_revalidation_2018,
	title = {Revalidation of the {RACE} scale after its regional implementation in {Catalonia}: a triage tool for large vessel occlusion},
	issn = {1759-8486},
	shorttitle = {Revalidation of the {RACE} scale after its regional implementation in {Catalonia}},
	doi = {10.1136/neurintsurg-2018-014519},
	abstract = {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{\textless}0.001). A RACE score ≥5 detected LVO with a sensitivity 0.79 and specificity 0.62 (AUC 0.76). Patients with RACE ≥5 harbored a LVO and received EVT more frequently than RACE {\textless}5 patients (LVO 35\% vs 6\%; EVT 20\% vs 6\%; all P{\textless}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.},
	language = {eng},
	journal = {Journal of Neurointerventional Surgery},
	author = {Carrera, David and Gorchs, Montse and Querol, Marisol and Abilleira, Sònia and Ribó, Marc and Millán, Mònica and Ramos, Anna and Cardona, Pedro and Urra, Xabier and Rodríguez-Campello, Ana and Prats-Sánchez, Luis and Purroy, Francisco and Serena, Joaquín and Cánovas, David and Zaragoza-Brunet, Josep and Krupinski, Jerzy A. and Ustrell, Xavier and Saura, Júlia and García, Sonia and Mora, Maria Àngela and Jiménez, Xavier and Dávalos, Antoni and Pérez de la Ossa, Natalia and {Catalan Stroke Code and Reperfusion Consortium (Cat-SCR)}},
	month = dec,
	year = {2018},
	pmid = {30580284},
	keywords = {Article, Neurologia, stroke, thrombectomy, thrombolysis}
}
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