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Review
. 2023 Nov 14;12(1):e10.
doi: 10.22037/aaem.v12i1.2152. eCollection 2024.

Rapid Arterial Occlusion Evaluation (RACE) Tool in Detecting Large Cerebral Vessel Occlusions; a Systematic Review and Meta-Analysis

Iman Chehregani Rad  1 , Amir Azimi  2
Affiliations
Review

Rapid Arterial Occlusion Evaluation (RACE) Tool in Detecting Large Cerebral Vessel Occlusions; a Systematic Review and Meta-Analysis

Iman Chehregani Rad et al. Arch Acad Emerg Med. .

Abstract

Introduction: Large vessel occlusion (LVO) strokes are linked to higher mortality rates and a greater risk of long-term disability. This study aimed to evaluate the diagnostic performance of the Rapid Arterial Occlusion Evaluation (RACE) tool in detecting LVO through a systematic review and meta-analysis.

Methods: A comprehensive search was conducted across online databases including PubMed, Embase, Scopus, and Web of Science, up to June 25th, 2023. Additionally, a manual search on Google and Google Scholar was performed to identify studies that assessed the diagnostic accuracy of the RACE scale in detecting LVO among patients with stroke symptoms.

Results: Data extracted from 43 studies were analyzed. The optimal cut-off points were determined to be 3 and 4, with a sensitivity of 0.86 (95% confidence interval (CI): 0.78, 0.91) and specificity of 0.57 (95% CI: 0.49, 0.67) for cut-off ≥3, and a sensitivity of 0.78 (95% CI: 0.70, 0.84) and specificity of 0.68 (95% CI: 0.59, 0.75) for cut-off ≥4. Subgroup meta-regression analysis revealed significant variations in sensitivity and specificity. RACE scale's sensitivity was significantly higher in LVO detection in suspected stroke cases, in pre-hospital settings, prospective design studies, and when considering both anterior and posterior occlusions for LVO definition. RACE scale's specificity was significantly higher when evaluating confirmed stroke cases, in-hospital settings, and considering only anterior occlusions for LVO definition and retrospective design studies. Notably, RACE exhibited higher sensitivity and specificity when utilized by neurologists and physicians compared to other emergency staff. Despite these variations, our study found comparable diagnostic accuracy across different conditions.

Conclusion: A high level of evidence indicates that the RACE scale lacks promising diagnostic value for detection of LVOs. A sensitivity range of 0.69 to 0.86 is insufficient for a screening tool intended to aid in the diagnosis of strokes, considering the substantial morbidity and mortality associated with this condition.

Keywords: Arterial occlusive diseases; Clinical decision rules; Diagnosis; Meta-analysis; Systematic review.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of current meta-analysis; LVO: Large vessels occlusion
Supplementary figure 1
Supplementary figure 1
Sensitivity, specificity, and diagnostic odds ratio of RACE in cut-off point of ≥2, in detecting LVO. RACE: Rapid Arterial Occlusion Evaluation; LVO: Large vessel occlusion; CI: confidence interval.
Supplementary figure 2
Supplementary figure 2
Sensitivity, specificity, and diagnostic odds ratio of RACE in cut-off point of ≥3, in detecting LVO. RACE: Rapid Arterial Occlusion Evaluation; LVO: Large vessel occlusion; CI: confidence interval.
Supplementary figure 3
Supplementary figure 3
Sensitivity, specificity, and diagnostic odds ratio of RACE in cut-off point of ≥4, in detecting LVO. RACE: Rapid Arterial Occlusion Evaluation; LVO: Large vessel occlusion; CI: confidence interval.
Supplementary figure 4
Supplementary figure 4
Sensitivity, specificity, and diagnostic odds ratio of RACE in cut-off point of ≥5, in detecting LVO. RACE: Rapid Arterial Occlusion Evaluation; LVO: Large vessel occlusion; CI: confidence interval.
Supplementary figure 5
Supplementary figure 5
Sensitivity, specificity, and diagnostic odds ratio of RACE in cut-off point of ≥6, in detecting LVO. RACE: Rapid Arterial Occlusion Evaluation; LVO: Large vessel occlusion; CI: confidence interval.
Supplementary figure 6
Supplementary figure 6
Sensitivity, specificity, and diagnostic odds ratio of RACE in cut-off point of ≥7, in detecting LVO. RACE: Rapid Arterial Occlusion Evaluation; LVO: Large vessel occlusion; CI: confidence interval.
Supplementary figure 7
Supplementary figure 7
Sensitivity, specificity, and diagnostic odds ratio of RACE in cut-off point of ≥8, in detecting LVO. RACE: Rapid Arterial Occlusion Evaluation; LVO: Large vessel occlusion; CI: confidence interval.
Supplementary figure 8
Supplementary figure 8
Sensitivity, specificity, and diagnostic odds ratio of RACE in cut-off point of≥ 9, in detecting LVO. RACE: Rapid Arterial Occlusion Evaluation; LVO: Large vessel occlusion; CI: confidence interval.
Supplementary figure 9
Supplementary figure 9
SROC and area under the curve of RACE in different cut-off points, in detecting LVO. RACE: Rapid Arterial Occlusion Evaluation; LVO: Large vessel occlusion; SROC: summary receiver operating characteristic.
Supplementary figure 10
Supplementary figure 10
Publication bias of RACE in different cut-off points, in detecting LVO. RACE: Rapid Arterial Occlusion Evaluation; LVO: Large vessel occlusion.
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