City of Las Vegas RACE Scale

The RACE scale is an assessment tool for use by Fire Paramedics and Ambulance Franchise Partners to determine appropriate treatment response to rapid arterial occlusion also known as stroke symptoms recognized when evaluating patients in the field. This tool predicts large vessel occlusion (LVO) in patients possibly suffering from acute stroke based on symptom presence of moderate to severe facial palsy, arm and leg motor impairment, head and eye gaze deviation with left or right hemiparesis.
 
Data has shown that patients with LVO have better outcomes at Endovascular Treatment Centers where patients with total scores greater than 5 should be transported as listed in protocols. A predictive tool for LVO that provides a quantitative stroke assessment helps medical and pre-hospital providers plan for faster, better care of stroke patients for EMS transport.
 
For patients with RACE Scale scores ≥5, a LVO should be considered as the cause and a plan put in place to get them definitive care at a Endovascular Treatment Center by EMS transport immediately.  
 
For patients with RACE Scale scores ≤4, an acute stroke should still be considered. However, as a lower score correlates with lower NIHSS score, these patients may not be candidates for invasive therapies or specific destination hospitals as per EMS protocols.
 
The RACE Scale was initially designed and validated for prehospital use by Pérez de la Ossa et al in Catalonia, Spain. The initial design was based on a retrospective cohort of 654 patients with an acute ischemic stroke. The scale was modeled after NIHSS values with a higher predictive value to include facial palsy, arm/leg motor function, gaze, and either aphasia or agnosia depending on the hemisphere involved.  
 
The RACE Scale is not a substitute for a full neurologic exam and NIHSS assessment.