A recent systematic review evaluated the diagnostic accuracy of 19 prehospital stroke scales.
Arm motor strength is the most frequently evaluated item by the scales (15/19), followed by gaze (13/19) and language (13/19).
Only 4 scales (RACE, LAMS, VAN, sNIHSS-EMS) were performed by paramedics in their original studies.
The NIHSS, LAMS, and VAN appear to have better results in predicting large vessel occlusion.
The presence of hemineglect, a sign of cortical involvement, improved the accuracy of the scale.
Answer
There is growing evidence for mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion.
Identification of potential eligible patients begin in the prehospital setting in order for preferential transport of these patients to comprehensive stroke centers.
Selected prehospital stroke scales:
RACE = Rapid Arterial Occlusion Evaluation Scale
LAMS = Los Angeles Motor Scale
VAN = Stroke Vision, Aphasia, Neglect Assessment
NIHSS = National Institute of Health Stroke Scale
References
Vidale S, Agostini E. Prehospital stroke scales and large vessel occlusion: A systematic review. Acta Neurol Scand. 2018 Feb 11. [Epub ahead of print]
