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April 8, 2025NeurologyOpen Access

Prehospital Large-Vessel Occlusion Stroke Detection Scales

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Why the study?

A head-to-head comparison of prehospital anterior-circulation large-vessel occlusion stroke detection scales was needed to guide implementation and determine which scale is most useful for triage in different regional contexts.

Does prehospital stroke scale assessment improve detection of anterior-circulation large-vessel occlusion in adult patients suspected of having a stroke?

Population

2,358 consecutive adult patients suspected of having a stroke within 6 hours of symptom onset

Comparison

Diagnostic performance of 14 reconstructed prehospital aLVO stroke detection scales

Design

Individual patient data analysis from 2 prospective observational cohort studies

Authors

LDLuuk DekkerJDJasper D. DaemsMAMariam Ali

Discussion

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Overview

RACE may be preferred for most prehospital triage but should not yet change practice; leaves open outcome trials.

Structured PICO

Does prehospital stroke scale assessment improve detection of anterior-circulation large-vessel occlusion in adult patients suspected of having a stroke?

P
Population
2,358 consecutive adult patients suspected by paramedics of having a stroke within 6 hours of symptom onset, from 4 Dutch ambulance regions (encompassing 15 stroke centers and serving 3.7 million people). Mean age 70 years, 47% female.
I
Intervention
14 prehospital anterior-circulation large-vessel occlusion (aLVO) stroke detection scales (including RACE, LAMS, G-FAST, mG-FAST, EMSA, CPSS3, CPSS3 + gaze, C-STAT, CPSS3 + C-STAT, FAST-PLUS, GPS, LAMS + speech, Prehospital Acute Stroke Severity, and CG-FAST) assessed by paramedics in the field before hospital arrival.
C
Comparator
Head-to-head comparison of the 14 reconstructed prehospital aLVO stroke detection scales.
O
Outcome
Final diagnosis of symptomatic aLVO ischemic stroke, defined as new neurologic deficits corresponding to an occlusion of the internal carotid artery, M1 or M2 segments of the middle cerebral artery, or A1 or A2 segments of the anterior cerebral artery, as assessed on CT angiography.

RACE, LAMS, G-FAST, and mG-FAST are the best-performing prehospital scales for detecting large-vessel occlusion stroke, with RACE showing the highest net benefit across various triage settings.

Limitations

  • Not all aLVO stroke scales could be reconstructed.
  • Diagnostic performance may vary across different populations and health care systems.
  • Conducted in the Netherlands, where stroke care is highly organized with relatively short distances between primary and thrombectomy-capable stroke centers.
  • The use of prehospital triage tools and training of paramedics are specific to the Dutch health care system.

Cite This Study

Dekker et al. (2025) studied this question.

synapsesocial.com/papers/6a7feb042cf87dafd7c85575https://doi.org/10.1212/wnl.0000000000213570
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparison of Prehospital Diagnostic Scores for Identifying Large Vessel Occlusions: A Systematic Review and Meta-Analysis2026
  2. 2Diagnostic performance of prehospital large-vessel occlusion detection scales in patients with suspected acute stroke: a retrospective validation study. The Akershus Study of Ischemic Stroke and Thrombolysis2026
  3. 3Stroke Scales for Large Vessel Occlusion in the Prehospital Emergency Setting: A Systematic Review and Meta‐Analysis2026
  4. 4Comparing RAMA-LVO with other Prehospital Large-Vessel Occlusion Prediction Scales in Suspected Acute Stroke; A Retrospective Cross-sectional Study2026
  5. 5Protocol for Systematic Review and Meta-Analysis of Prehospital Large Vessel Occlusion Screening Scales2024 · 1 citations