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. 2025;15(1):39-47.
doi: 10.1159/000543260. Epub 2024 Dec 24.

Predictive Value of the Prehospital RACE Scale for Large Vessel Occlusion in Acute Stroke Patients

Anh Tuan Le Truong  1   2 , Hang Thi Minh Tran  1   2 , Loc Dang Phan  1 , Huong Bich Thi Nguyen  1 , Trung Quoc Nguyen  1 , Tra Vu Son Le  3 , Duc Nguyen Chiem  1 , Huy Nguyen  4 , Thanh N Nguyen  5 , Thang Huy Nguyen  1   2
Affiliations

Predictive Value of the Prehospital RACE Scale for Large Vessel Occlusion in Acute Stroke Patients

Anh Tuan Le Truong et al. Cerebrovasc Dis Extra. 2025.

Abstract

Introduction: Prehospital stroke scales have been developed to identify anterior large vessel occlusion (LVO) in acute ischemic stroke (AIS) patients for direct transport to thrombectomy-capable hospitals. However, its performance in a Vietnamese population remains unknown. We aimed to evaluate the predictive value of the Rapid Arterial oCclusion Evaluation (RACE) scale for LVO detection in patients with ischemic stroke presenting within 24 h in Vietnam.

Methods: This was a prospective study of patients with AIS admitted at People's 115 Hospital between May 2022 and October 2022. All patients were assessed with the RACE scale with five items: facial palsy (scored 0-2), arm motor function (0-2), leg motor function (0-2), gaze (0-1), and aphasia or agnosia (0-2). LVO was diagnosed by CTA or MRA. Receiver operating characteristic curve, sensitivity, specificity, and accuracy of the RACE scale were analyzed to evaluate its predictive value for LVO.

Results: There were 318 patients included. LVO was detected in 121/318 patients (37.6%). The higher the RACE score, the higher the proportion of patients with LVO (p < 0.001). Receiver operating characteristic curves showed capacity to predict LVO of the RACE scale with an area under the curve (AUC) of 0.767. The optimal RACE cutoff was ≥5 with sensitivity = 0.68, specificity = 0.79, positive predictive value = 0.67, negative predictive value = 0.80, and overall accuracy = 0.75. RACE ≥5 had higher sensitivity and same specificity for detecting LVO in AIS patients within 6-h versus 6-24-h window (AUC = 0.79 vs. 0.75, sensitivity = 0.74 vs. 0.65, specificity = 0.79 vs. 0.80, accuracy = 0.77 vs. 0.74).

Conclusions: The RACE scale is a simple tool that can accurately identify AIS patients with LVO. This tool may be useful for early detection of LVO patients and should be validated in the prehospital setting in Vietnam.

Keywords: Acute ischemic stroke; Large vessel occlusion; Prehospital stroke scales; RACE scale.

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Conflict of interest statement

The authors disclosed no potential conflicts of interest regarding the research, authorship, or publication of this article. Thanh N. Nguyen reports advisory board for Idorsia, Brainomix, Associate Editor of Stroke.

Figures

Fig. 1.
Fig. 1.
Flowchart study selection.
Fig. 2.
Fig. 2.
Proportion of patients with ischemic stroke with anterior LVO (gray) and ischemic stroke without LVO (black) for every RACE scale score.
Fig. 3.
Fig. 3.
a ROC curves of the RACE scale for the detection of anterior LVO strokes (all subjects). b ROC curves of the RACE scale for the detection of anterior LVO strokes (subgroups).
Fig. 4.
Fig. 4.
Probability of anterior LVO and EVT in patients with ischemic stroke with a RACE score ≥5 and RACE score <5.
See this image and copyright information in PMC

References

    1. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. . Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–18. - PMC - PubMed
    1. Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31. - PubMed
    1. Nguyen HT, Ton MD, Vu DL, Churojana A, Nilanont Y, Ayudya SPSN, et al. . Post‐market registry of stroke patients treated with medtronic neurothrombectomy devices in southeast asia: prospr‐sea. Stroke: Vasc Interv Neurol. 2023;3(6):e000318.
    1. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. . Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21. - PubMed
    1. Nguyen TQ, Tran MH, Phung HN, Nguyen KV, Tran HTM, Walter S, et al. . Endovascular treatment for acute ischemic stroke beyond the 24-h time window: selection by target mismatch profile. Int J Stroke. 2024;19(3):305–13. - PubMed