A Race Utilizing the RACE Score to Optimize Prehospital Triage in Large Vessel Occlusion
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Christina Hicks
College:
The College of Health Professions and Human Services
Major:
Nursing
Faculty Research Advisor(s):
Ibtihal Al Makhzoomy
Abstract:
Abstract
Background
In stroke cases, every minute is crucial. The American Heart Association (AHA) established the "Target Stroke'' program to enforce stringent targets for hospitals nationwide, aiming to enhance outcomes for stroke patients eligible for thrombolytic therapy or Endovascular Therapy (EVT). Phase III of this program assesses door-to-needle time for IV thrombolytics and door-to-device time for EVT. According to the "mothership" model, prehospital identification of Large Vessel Occlusion (LVO) can lead to improved patient outcomes and reduced transport time by directing patients straight to a Comprehensive Stroke Center (CSC) providing EVT (Holondinsky et al., 2017). Research supports the Rapid Arterial Occlusion Evaluation (RACE) scale as a valid tool for Emergency Medical Services (EMS) stroke triage (Carrer, D., Campell, B., et al., 2019). This project will involve a 15-hospital network in New Jersey. EMS will assess patients using the RACE stroke scale, transporting those with a score higher than five immediately to a nearby comprehensive center if within a 45-minute driving distance. Timing and outcomes will be recorded to determine the time from first medical contact to endovascular treatment and the rate of over-triage.
Aim
This review aims to provide insights into the urgency of prompt stroke treatment, the role of EMS in prioritizing and transporting patients to appropriate stroke treatment, and recommended implementation strategies.
Method
Using the PRISMA framework, a systematic review of published literature was conducted from January 2017 to December 2023, utilizing databases such as CINAHL, MEDLINE, and PubMed. Inclusion criteria encompassed ground-based EMS, prehospital stroke triage scales, and improved transportation times for possible LVO cases. Papers predating January 2017 and articles concerning mobile stroke units were excluded. Rapid critical appraisal led to the selection of 12 studies.
Implementation
Following the Iowa model, an educational intervention will be delivered to the EMS department, covering Primary Stroke Centers (PSC), CSC, and proper application of the RACE stroke score. Instruction will also address when to initiate bypass of a PSC and transport patients directly to a CSC.
Results
EMS training will focus on using the RACE stroke scale to prioritize patients with LVO and transport them directly to a CSC for EVT. Strategies for evaluating intervention outcomes will be devised, including first medical contact-to-treatment time and over-triage rate.
Recommendations/Implications
The adage 'time is brain' underscores the critical role of prompt EMS action in directing patients to appropriate facilities. Inter-facility transfers can consume valuable time. EMS education on utilizing the RACE score to prioritize LVO patients and transport them directly to a CSC for endovascular clot removal is paramount.