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    Rapid Arterial oCclusion Evaluation (RACE) Scale for Stroke

    Predicts large vessel occlusion (LVO) in patients with acute stroke.
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    BEFORE USE

    Use in the prehospital setting (i.e., by EMS providers) in patients with stroke symptoms.

    When to Use
    Pearls/Pitfalls
    Why Use
    Content Contributors
    • Matthew White, DO

    Result:

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    Advice

    • For patients with RACE Scale scores ≥5, an LVO should be considered as the cause and a plan put in place to get them definitive care at a Comprehensive Stroke Center as quickly as possible.  
    • For patients with a RACE Scale scores ≤4, an acute stroke should still be considered. However, as lower score correlates with lower NIHSS score, these patients may not be candidates for invasive therapies.

    Management

    Consider consultation with a neurologist, early CT imaging (non-contrast and CT angiography), blood pressure and blood glucose control. Consider tPA after an assessment of contraindications and possible transfer to a Comprehensive Stroke Center if indicated.

    Critical Actions

    • The RACE Scale is not a substitute for a full neurologic exam and NIHSS assessment in the ED. Emergency physicians and hospital personnel should still think of and try to exclude other causes of neurologic deficits such as intracerebral hemorrhage (ICH), hypoglycemia, Todd’s paralysis, complex migraines, exacerbation of prior deficits from a new metabolic source, etc.  
    • Early imaging and consultation with a neurologist are important.  If the neurologic deficit is deemed to be from an ischemic event, then IV thrombolysis should be considered and definitive care at a Comprehensive Stroke Center should be considered.
    Content Contributors
    • Matthew White, DO