Prehospital Scales to Identify Patients With Large Vessel Occlusion: It Is Time for Action.

Abstract

Recent confirmation of mechanical thrombectomy efficacy is putting pressure on stroke systems of care, most of which were created and developed in the thrombolysis era to ease the access of patients with stroke to stroke unit care and intravenous thrombolysis. The advent of the endovascular treatment (EVT) for acute ischemic strokes caused by large artery occlusions and the evidence that EVT benefit declines with increasing time after symptom onset force us to consider and favor systems of care that prioritizes rapid access to EVT in an equitable way. In a study performed in Catalonia, patients living in areas primarily covered by nonendovascular stroke centers are 3× less likely to receive EVT than patients living in metropolitan areas.1 This unbalance justifies significantly changing the way we triage patients with stroke at the prehospital level, and the development of simple clinical scales by Emergency Medical Services is, therefore, of crucial importance. During the past 2 years, many clinical scales have been explored for their capacity to identify patients with Emergent Large Vessel Occlusion (ELVO; Table), including different items and different categories. Some of them include an arbitrary selection of items, …