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Clinical Trial
. 2018 Mar;49(3):565-572.
doi: 10.1161/STROKEAHA.117.019228. Epub 2018 Feb 19.

Los Angeles Motor Scale to Identify Large Vessel Occlusion: Prehospital Validation and Comparison With Other Screens

Ali Reza Noorian  1 , Nerses Sanossian  2 , Kristina Shkirkova  2 , David S Liebeskind  2 , Marc Eckstein  2 , Samuel J Stratton  2 , Franklin D Pratt  2 , Robin Conwit  2 , Fiona Chatfield  2 , Latisha K Sharma  2 , Lucas Restrepo  2 , Miguel Valdes-Sueiras  2 , May Kim-Tenser  2 , Sidney Starkman  2 , Jeffrey L Saver  2 ; FAST-MAG Trial Investigators and Coordinators
Affiliations
Clinical Trial

Los Angeles Motor Scale to Identify Large Vessel Occlusion: Prehospital Validation and Comparison With Other Screens

Ali Reza Noorian et al. Stroke. 2018 Mar.

Abstract

Background and purpose: Prehospital scales have been developed to identify patients with acute cerebral ischemia (ACI) because of large vessel occlusion (LVO) for direct routing to Comprehensive Stroke Centers (CSCs), but few have been validated in the prehospital setting, and their impact on routing of patients with intracranial hemorrhage has not been delineated. The purpose of this study was to validate the Los Angeles Motor Scale (LAMS) for LVO and CSC-appropriate (LVO ACI and intracranial hemorrhage patients) recognition and compare the LAMS to other scales.

Methods: The performance of the LAMS, administered prehospital by paramedics to consecutive ambulance trial patients, was assessed in identifying (1) LVOs among all patients with ACI and (2) CSC-appropriate patients among all suspected strokes. Additionally, the LAMS administered postarrival was compared concurrently with 6 other scales proposed for paramedic use and the full National Institutes of Health Stroke Scale.

Results: Among 94 patients, age was 70 (±13) and 49% female. Final diagnoses were ACI in 76% (because of LVO in 48% and non-LVO in 28%), intracranial hemorrhage in 19%, and neurovascular mimic in 5%. The LAMS administered by paramedics in the field performed moderately well in identifying LVO among patients with ACI (C statistic, 0.79; accuracy, 0.72) and CSC-appropriate among all suspected stroke transports (C statistic, 0.80; accuracy, 0.72). When concurrently performed in the emergency department postarrival, the LAMS showed comparable or better accuracy versus the 7 comparator scales, for LVO among ACI (accuracies LAMS, 0.70; other scales, 0.62-0.68) and CSC-appropriate (accuracies LAMS, 0.73; other scales, 0.56-0.73).

Conclusions: The LAMS performed in the field by paramedics identifies LVO and CSC-appropriate patients with good accuracy. The LAMS performs comparably or better than more extended prehospital scales and the full National Institutes of Health Stroke Scale.

Keywords: ambulances; brain ischemia; cerebral hemorrhage; thrombectomy; triage.

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Conflict of interest statement

Conflicts of Interest/Disclosures: None.

Figures

Figure 1
Figure 1
Deficit severity scores of acute cerebral ischemia patients with large vessel occlusions (LVO). medium vessel occlusions (MVO), and no visualized occlusion, on: A) the Los Angeles Motor Scale performed in the field by paramedics, and B) the full NIH Stroke Scale performed in the ED after hospital arrival.
Figure 1
Figure 1
Deficit severity scores of acute cerebral ischemia patients with large vessel occlusions (LVO). medium vessel occlusions (MVO), and no visualized occlusion, on: A) the Los Angeles Motor Scale performed in the field by paramedics, and B) the full NIH Stroke Scale performed in the ED after hospital arrival.
Figure 2
Figure 2
Comparative performance of 8 scales administered concurrently after ED arrival, in identifying: A) large vessel occlusions among all patients with acute cerebral ischemia, and B) CSC-Appropriate patients among all suspected stroke transports.
Figure 2
Figure 2
Comparative performance of 8 scales administered concurrently after ED arrival, in identifying: A) large vessel occlusions among all patients with acute cerebral ischemia, and B) CSC-Appropriate patients among all suspected stroke transports.
See this image and copyright information in PMC

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