Large Vessel Occlusion Stroke Triage—Combined Utility Of Mobile Stroke Unit And Clinical Severity Scoring Systems (5132)

Objective: To determine the accuracy of clinical severity based LVO scoring systems in a mobile stroke unit. Background: Mobile stroke units (MSU) have the ability to offer novel radiological information including detection of hemorrhage in addition to clinical scoring systems in the pre-hospital setting. Data regarding the added benefit of MSU and the performance of clinical scoring systems in the triage of large vessel occlusion (LVO) strokes is scarce. The purpose of this study is to increase the accuracy of prehospital stroke assessment validating the Rapid Arterial oClusion Evaluation (RACE) score scale in the Barrow Emergency Stoke Treatment Unit (BESTU) to capture patients with potential large vessel occlusion to be taken to a thrombectomy capability center. Design/Methods: Retrospective data was collected from 478 MSU patients with a possible diagnosis of stroke from October 2017 to June 2020. Patient’s data was gathered by emergency medical services, onboard experience stroke registered nurses and telemedicine stroke neurologists. Sensitivity and specificity analyses were performed to detect the accuracy of NIHSS score 10 and RACE score 5, with and without radiological imaging data, to detect LVO (ICA/ M1/ M2/ Basilar artery) stroke. Results: Of the 478 MSU activations, median NIHSS score was 4 (1–10) and median RACE score was 2 (0–4). 219 were strokes (ischemic 167, TIA 19 and hemorrhagic 34 patients). 21 of the 167 ischemic strokes had a LVO. Amongst all patients, sensitivity and specificity of NIHSS score 10 (85.7%, 76.4%) and RACE score 5 (71.4%, 82.3%) were calculated. Amongst patients with hemorrhage on CT head in MSU, specificity of NIHSS 10 increased to 79.4% and specificity of RACE 5 increased to 85.3% Conclusions: Addition of radiological imaging data acquired in the mobile stroke unit has the potential to improve triage of LVO strokes by increasing specificity of clinical stroke severity based scoring systems. Disclosure: Dr. Pauta Martinez has nothing to disclose. Dr. Desai has nothing to disclose. Tiffany Sheehan has nothing to disclose. Dr. Ashary has nothing to disclose. Dr. Jadhav has nothing to disclose. Dr. Waters has nothing to disclose.