Background and Purpose: Mechanical thrombectomy (MT) is the treatment standard for large vessel occlusion (LVO) stroke. In 2019, the American Heart Association (AHA) launched Target: Stroke Phase III , setting a goal to achieve Door to Device (DTD) within 90 minutes for patients who arrive from the field. The Los Angeles Motor Scale (LAMS) is a validated prehospital tool shown to predict anterior LVOs with high sensitivity and specificity, facilitating early identification of LVOs. At our institution, the Emergency Department (ED) Mobile Intensive Care Nurses (MICNs) calculate LAMS based on Emergency Medical Service (EMS) report and alerts the stroke team to mobilize prior to patient arrival. This study aims to determine if prenotification with a high LAMS score is associated with shorter DTD times for MT. Methods: We performed a retrospective study of ischemic stroke patients brought in by EMS with a calculated LAMS score from January 2022- June 2025. The inclusion criteria includes (1) stroke caused by LVO confirmed on CTA, (2) arrival from the field via EMS, and (3) documented first pass for MT. Patients with documented reasons for DTD delay, outlined by Get With The Guidelines criteria, were excluded. Demographic, clinical, and imaging data was collected via chart review. Both univariate and multivariant analyses were applied to assess associations. A p-value <0.05 was considered significant. Results: A total of 126 patients met inclusion criteria: 89 had LAMS scores calculated, 39 had no documented LAMS. Patients without a documented LAMS had a mean DTD time of 110 minutes (SD = 23.2). Patients with LAMS prenotification had a mean DTD time of 121 minutes (SD = 29.2). Within the prenotification group, patients with high LAMS (4-5) (n=40) had a mean DTD of 116 minutes (SD = 28.8), compared to 125 minutes (SD = 30) in patients with low LAMS (0-3) (n=49) (p=0.1527). This difference was not statistically significant. Conclusions: Although patients with high LAMS had faster DTD times, it was not statistically significant. Interestingly, cases where LAMS was not documented were also associated with shorter DTD times, though the reason is unclear. These findings suggest that LAMS prenotification may be a useful tool to identify LVOs in the field and facilitate early triage. Further study is needed to clarify the relationship between LAMS documentation and treatment times, and to establish the impact of LAMS prenotification on workflow efficiency.
Stradling et al. (Thu,) studied this question.