Neurology® Podcast Prehospital Large-Vessel Occlusion Stroke Detection Scales
Jun 30, 2025
Dr. Luuk Dekker, a neurologist from Leiden University Medical Center and Haga Hospital, discusses critical advancements in prehospital stroke detection. He dives into the effectiveness of multiple large-vessel occlusion detection scales, spotlighting the rapid arterial occlusion evaluation scale. The conversation highlights the role of well-trained paramedics and the impact of regional differences in stroke care. Dekker emphasizes the need for customized detection strategies and the integration of new technologies to improve patient outcomes.
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Many Prehospital LVO Scales Identified
- The study identified 63 different prehospital stroke scales targeting anterior circulation large vessel occlusion (aLVO). - From these, 14 scales were reconstructed and compared using over 2,300 patient data points for diagnostic performance.
RACE Scale Performs Best Globally
- The RACE scale showed the highest balanced diagnostic accuracy for detecting LVO stroke with AUC 0.81. - Sensitivity and specificity trade-offs make some other scales better suited for specific regional priorities.
Adapt Scale Choice to Regional Context
- Regions should consider their stroke center density, EMS capacity, and transport times when choosing a stroke scale. - Paramedic training level and local stroke organization impact scale performance and feasibility.