Los Angeles Motor Scale to Identify Large Vessel Occlusion

Noorian, Ali Reza; Sanossian, Nerses; Shkirkova, Kristina; Liebeskind, David S; Eckstein, Marc; Stratton, Samuel J.; Pratt, Franklin D; Conwit, Robin; Chatfield, Fiona; Sharma, Latisha; Restrepo, Lucas; Valdes-Sueiras, Miguel; Kim-Tenser, May; Starkman, Sidney; Saver, Jeffrey L.

doi:10.1161/strokeaha.117.019228

Cited by 101 publications

(65 citation statements)

References 41 publications

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“…This was the most accurate model when compared to the chance level of prediction (52%, Table 3 ). For comparison, currently used prehospital stroke scales such as the Los Angeles Motor Scales which are designed to designed to detect stroke from large vessel occlusion have reported a comparable accuracy of 0.72 36 . Future studies are needed to determine the additive value of the Muse headband.…”

Section: Discussionmentioning

confidence: 99%

Predicting stroke severity with a 3-min recording from the Muse portable EEG system for rapid diagnosis of stroke

Wilkinson

Burrell

Kuziek

et al. 2020

Sci Rep

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In this study, we demonstrated the use of low-cost portable electroencephalography (EEG) as a method for prehospital stroke diagnosis. We used a portable EEG system to record data from 25 participants, 16 had acute ischemic stroke events, and compared the results to age-matched controls that included stroke mimics. Delta/alpha ratio (DAR), (delta + theta)/(alpha + beta) ratio (DBATR) and pairwise-derived Brain Symmetry Index (pdBSI) were investigated, as well as head movement using the on-board accelerometer and gyroscope. We then used machine learning to distinguish between different subgroups. DAR and DBATR increased in ischemic stroke patients with increasing stroke severity (p = 0.0021, partial η2 = 0.293; p = 0.01, partial η2 = 0.234). Also, pdBSI decreased in low frequencies and increased in high frequencies in patients who had a stroke (p = 0.036, partial η2 = 0.177). Using classification trees, we were able to distinguish moderate to severe stroke patients and from minor stroke and controls, with a 63% sensitivity, 86% specificity and accuracy of 76%. There are significant differences in DAR, DBATR, and pdBSI between patients with ischemic stroke when compared to controls, and these effects scale with severity. We have shown the utility of a low-cost portable EEG system to aid in patient triage and diagnosis as an early detection tool.

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Section: Discussionmentioning

confidence: 99%

Predicting stroke severity with a 3-min recording from the Muse portable EEG system for rapid diagnosis of stroke

Wilkinson

Burrell

Kuziek

et al. 2020

Sci Rep

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“…New specific scales for LVO patients have been created, but most are still uncommon in EMS [ 32 , 33 , 34 ]. Our group developed and validated the RACE scale [ 12 ] in 2014, which has received endorsement by international guidelines [ 35 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

An Online Training Intervention on Prehospital Stroke Codes in Catalonia to Improve the Knowledge, Pre-Notification Compliance and Time Performance of Emergency Medical Services Professionals

Gorchs-Molist

Solà-Muñoz²,

Enjo-Perez

et al. 2020

IJERPH

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Strokes are a time-dependent medical emergency. The training of emergency medical service (EMS) professionals is essential to ensure the activation of stroke codes with pre-notification, as well as a rapid transfer to achieve early therapy. New assessment scales for the detection of patients with suspected large vessel occlusion ensures earlier access to endovascular therapy. The aim of this study was to evaluate the impact on an online training intervention focused on the Rapid Arterial oCclusion Evaluation (RACE) scoring of EMS professionals based on the prehospital stroke code in Catalonia from 2014 to 2018 in a pre–post intervention study. All Catalonian EMS professionals and the clinical records from primary stroke patients were included. The Kirkpatrick model guided the evaluation of the intervention. Data were collected on the knowledge on stroke recognition and management, pre-notification compliance, activated stroke codes and time performance of EMS professionals. Knowledge improved significatively in most items and across all categories, reaching a global achievement of 82%. Pre-notification compliance also improved significantly and remained high in the long-term. Increasingly higher notification of RACE scores were recorded from 60% at baseline to 96.3% in 2018, and increased on-site clinical care time and global time were also observed. Therefore, the online training intervention was effective for increasing EMS professionals’ knowledge and pre-notification compliance upon stroke code activation, and the wide adoption of a new prehospital scale for the assessment of stroke severity (i.e., the RACE scale) was achieved.

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“…This study also compares VAN with the pre-existing and validated LVO screening tools like RACE, CPSS, and FAST-ED. [3][4][5] Our study confirms that VAN is comparable to other LVO screening tools 0 (0-1) 1 (0-2) 0 (0-0) 1 (.86-1.14)* Visual fields baseline: median (IQR) 0 (0-1) 1 (0-2) 0 (0-0) 1 (.73-1.27) a Right upper extremity baseline: Median (IQR) 0 (0-1) 1 (0-3) 0 (0-1) 1 (.59-1.41)* Left upper extremity baseline: median (IQR) 0 (0-1) 1 (0-3) 0 (0-1) 1 (.73-1.27)* Language baseline: median (IQR) 0 (0-1) 2 (0-2) 0 (0-1) 2 (1.86-2.14) Neglect baseline: median (IQR) 0 (0-0) 0 (0-1) 0 (0-0) 0 (À.14-.14)* Any arm weakness: n (%) except Los Angeles Motor Scale (LAMS), 6 which we could not extrapolate in this study based on NIHSS due to absence of data on distal limb strength. Advantages of VAN include an easy to administer test as the mnemonic guides the examination steps and the results are dichotomous either positive or negative, thus no score calculation is required.…”

Section: Discussionmentioning

confidence: 99%

“…Our study shows a higher accuracy for VAN 72% and a higher NPV 88% compared to that study. 6 VAN and FAST-ED are the only 2 LVO screening tools that rely heavily on cortical signs for prediction of LVO. AIS have 4 times higher odds of having an LVO if they have any of the cortical signs (vision, aphasia, or neglect) on exam in our study.…”

Section: Discussionmentioning

confidence: 99%

Vision, Aphasia, Neglect Assessment for Large Vessel Occlusion Stroke

Navalkele

Vahidy

Kendrick

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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Los Angeles Motor Scale to Identify Large Vessel Occlusion

Abstract: The LAMS performed in the field by paramedics identifies LVO and CSC-appropriate patients with good accuracy. The LAMS performs comparably or better than more extended prehospital scales and the full National Institutes of Health Stroke Scale.

Cited by 101 publications

References 41 publications

Predicting stroke severity with a 3-min recording from the Muse portable EEG system for rapid diagnosis of stroke

Predicting stroke severity with a 3-min recording from the Muse portable EEG system for rapid diagnosis of stroke

An Online Training Intervention on Prehospital Stroke Codes in Catalonia to Improve the Knowledge, Pre-Notification Compliance and Time Performance of Emergency Medical Services Professionals

Vision, Aphasia, Neglect Assessment for Large Vessel Occlusion Stroke

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