The significance of the RACE (Rapid Arterial Occlusion Evaluation) scale in acute ischemic stroke

Abstract

Introduction: Endovascular mechanical thrombectomy performed within the first 6 hours after the start of symptoms, with or without thrombolytic therapy, significantly reduces disability in patients with acute ischemic stroke and large vessel occlusion (LVO). The effectiveness of therapeutic modalities decreases over time recording the period from the start of symptoms to the therapeutic application. Identification of patients with ischemic stroke and LVO at the prehospital level is crucial for expedited transport to comprehensive endovascular centers. Objectives: To indicate the advantages and benefits of RACE scale in detecting patients with stroke and LVO in the prehospital settings. Methodology: A systematic review of the professional literature was performed in the index databases and leading scientific journals. The findings were systematized based on results and commented in the discussion. Results: The neurological "gold standard" for stroke severity rating is the National Institutes of Health Stroke Scale (NIHSS). Due to its complexity and time consuming there is a modified version created for the prehospital assessment called the Rapid Arterial Occlusion Evaluation (RACE) scale. For Emergency Medical Services the RACE scale represents a simple and practical screening test for LVO prediction, assessing 5 variables from the NIHSS scale, including motor and cortical functions. Conclusion: With higher sensitivity and slightly less specificity, the RACE scale could be an almost ideal prehospital test for LVO prediction. In our environment the RACE scale should become an integral part of the prehospital algorithms and connection between emergency physicians and vascular neulogists.

Keywords

• ischemic stroke
• race
• emergency medical service
• thrombectomy