Identify LVO

[NomadicMedic]

I’m curious how many services are using RACE scores to help identify potential LVO in the field and if you have protocols to bypass a primary stroke center to take those patients to an EVT equipped comprehensive stroke center.

I attended a class on driving prehospital stroke care and this idea is a prime directive, however, only 2 of the participants in the room were using RACE scores system wide and there wasn’t a real protocol in place at either of those services.

 

[MonkeyArrow]

Just so we're clear on some of the acronyms: LVO is large vein occlusion and EVO is endovascular vein occlusion?

 

[agregularguy]

We use RACE scores in conjunction with the Cincinnati stroke scale. Most of our trucks have tear off pads/check sheets in most of the trucks with the qualifiers on them. I also have a RACE score app on my phone. Anyone with a RACE of 5 or greater has to go to one of the two of the main downtown hospitals.

 

[EpiEMS]

only 2 of the participants in the room were using RACE scores system wide and there wasn’t a real protocol in place at either of those services.

My stroke protocol uses the Cincinnati scale, which is OK...

RACE seems better as far as specificity, which is good to see. Might make RACE a worthy consideration.

 

[NomadicMedic]

I’m curious how many services are using RACE scores to help identify potential LVO in the field and if you have protocols to bypass a primary stroke center to take those patients to an EVO equipped comprehensive stroke center.

I attended a class on driving prehospital stroke care and this idea is a prime directive, however only 2 of the participants in the room were using RACE scores system wide and there wasn’t a real protocol in place at either of those services.

Just so we're clear on some of the acronyms: LVO is large vein occlusion and EVO is endovascular vein occlusion?

Sorry, that should be EVT, endovascular therapy or treatment. And yes, LVO is a Large Vessel Occlusion. Some services use ELVO. Emergent Large Vessel Occlusion.

 

[NPO]

We use both CPSS and RACE. CPSS is a quantitative assessment and RACE is a qualitative. One should not necessarily replace the other.

We use RACE and do have protocols to bypass our local hospital for a Level 1 Stoke center further away.

The problem I've had is that on both of my most recent strokes (since I've started working here), neither has been conscious enough to preform either assessment. One was a brain bleed, the other I'm still waiting for follow up on.

 

[EpiEMS]

CPSS is a quantitative assessment and RACE is a qualitative.

You know, that reminds me...they're all kinda based off the NIHSS, in various forms, I think - CPSS is very simplified to rule in stroke, while RACE is more detailed and focused on LVO, as discussed elsewhere.

 

[NPO]

You know, that reminds me...they're all kinda based off the NIHSS, in various forms, I think - CPSS is very simplified to rule in stroke, while RACE is more detailed and focused on LVO, as discussed elsewhere.

Correct. That's the idea anyway. RACE will not tell you IF someone is having a stroke, just how bad of stroke it is.

 

[VFlutter]

The current literature suggest that there is no benefit of tPA prior to thrombectomy in LVO and that thrombectomy alone has better outcomes with same complications rates so closest facility with tPA may not be the most appropriate. Do you have the discretion to decide that the comprehensive stroke center is the closest appropriate facility or do you need medical control / protocol?

 

[FLMedic311]

Using LAMS Score here

 

[Tigger]

The current literature suggest that there is no benefit of tPA prior to thrombectomy in LVO and that thrombectomy alone has better outcomes with same complications rates so closest facility with tPA may not be the most appropriate. Do you have the discretion to decide that the comprehensive stroke center is the closest appropriate facility or do you need medical control / protocol?

We will divert if it adds less than 15 minutes of transport time at my city job. I am not sure how they came to that number. At my primary job in the sticks we are working very hard to convince the medical director that taking all the strokes to the six bed ED with TPA is a bad idea. Most strokes I fly to a comprehensive center or if we're closer in I find a reason to go to a real hospital. The TPA is of questionable benefit anyway, and the local hospital's door to TPA time is like 80 something minutes. We also can't transport TPA hanging. Just not good all around.

 

[SandpitMedic]

We're still using the old Cincinnati here.
We are not supposed to bypass stroke centers.
I have in cases where I suspected a bleed in lieu of a suspected clot.

 

[FiremanMike]

Our protocol calls for the LAMS to be used for transport decisions, with a 4-5 going to a comprehensive.

The closest hospital to our run district is a comprehensive stroke center though.