Abstract WP292: Differential Ability of Prehospital Large Vessel of Occlusion Scales to Identify Intracranial Hemorrhage

Abstract

Background: Prehospital scales have been developed to identify patients with acute cerebral ischemia large vessel occlusion (ACI LVO) for direct routing to endovascular procedures. However intracranial hemorrhage patients can benefit significantly when directed to comprehensive stroke centers with neurosurgical services, but few prehospital scales have been validated for the detection of intracranial hemorrhage. Purpose: Differentiate the ability of prehospital large vessel of occlusion scales, such as LAMS, FAST-ED, RACE, and C-STATS to identify intracranial hemorrhage Methods: We analyzed early assessment and outcome data prospectively gathered in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium phase 3) among patients with acute cerebrovascular disease (cerebral ischemia and intracranial hemorrhage) within 2 hours of onset, transported by 315 ambulances to 60 receiving hospitals. Results: Among 1700 patients (age 69±13 years, female 42.6%) 73.3% of patients had final diagnosis of cerebral ischemia, 22.8% diagnosis of intracranial hemorrhage, and 3.9% had stroke-mimicking conditions. Time from onset to prehospital LAMS was median 30 minutes (IQR 20-50), onset to hospital arrival LAMS was 145 minutes (IQR 119-180). All 4 scales performed moderately well in identifying ICH among patients with ACI: LAMS 0.75 C statistic; 0.63 accuracy; FAST-ED 0.72 C-statistic, 0.65 accuracy; RACE 0.70 C-statistic, 0.64 accuracy; C-STATS 0.71 C statistic, 0.67 accuracy. Conclusions: The prehospital LAMS and ED-performed C-STAT, RACE, and FAST-ED performed roughly equally at identifying Intracranial Hemorrhage patients with good accuracy.