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    Patent Pending

    Rapid Arterial oCclusion Evaluation (RACE) Scale for Stroke

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

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

    When to Use
    Pearls/Pitfalls
    Why Use

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

    • The RACE Scale for Stroke is based on the well-known NIH Stroke Scale assessment and predicts stroke caused by large vessel occlusion (LVO).
    • Provides quicker assessment than NIHSS for use in the prehospital environment to help predict LVO.  
    • While there are 11 points on the scale itself, the assessment is done based on the side of the patient’s neurologic deficits, so it is important to remember that the maximum score is 9. Depending on the patient’s deficits, testing is done for either aphasia or agnosia, not both.
    • While not as comprehensive as the NIHSS assessment, the RACE Scale is a much more rapid tool that still retains sensitivity for severe strokes.
    • Several other well-known prehospital stroke scales exist, such as the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS), but they are all qualitative scales designed to rule in or rule out a stroke.  
    • The RACE Scale is the first major quantitative assessment to help predict LVO and thus identify which patients may be best served at a Comprehensive Stroke Center.
    • Data show that patients with LVO have better outcomes at Comprehensive Stroke Centers with endovascular options such as mechanical thrombectomy. Not all stroke patients fit into this category.  
    • A sensitive, predictive tool for LVOs that provides a quantitative stroke assessment helps prehospital providers and medical control plan for faster, better care of stroke patients coming via EMS.
    Absent
    0
    Mild
    +1
    Moderate to severe
    +2
    Normal to mild
    0
    Moderate
    +1
    Severe
    +2
    Normal to mild
    0
    Moderate
    +1
    Severe
    +2
    Absent
    0
    Present
    +1
    Left
    Right

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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
    About the Creator
    Dr. Natalia Pérez de la Ossa
    Are you Dr. Natalia Pérez de la Ossa?
    Content Contributors
    • Matthew White, DO