scholarly journals Real-World Field Performance of the Los Angeles Motor Scale as a Large Vessel Occlusion Screen: A Prospective Muticentre Study

2021 ◽  
pp. 1-8
Author(s):  
Tej G. Stead ◽  
Paul Banerjee ◽  
Latha Ganti
Keyword(s):  
Los Angeles ◽  
Predictive Validity ◽  
Real World ◽  
Urban Areas ◽  
Large Vessel ◽  
Hospital Death ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Discharge Disposition ◽  
Los Angeles Motor Scale

<b><i>Background:</i></b> The Los Angeles Motor Scale (LAMS) is a 3-item, 0-to-5-point motor stroke-deficit scale derived from the Los Angeles Prehospital Stroke Screen. We assessed the predictive validity (for interventions performed and discharge disposition) of the LAMS performed in the field by paramedics in a geographic region of over 5,200 km<sup>2</sup>, covering both rural and urban areas. <b><i>Methods:</i></b> We analyzed data gathered from Phase I of the LIT-PASS study (Large Vessel Occlusion Identification Through Prehospital Administration of Stroke Scales) which included all patients with suspected acute cerebrovascular disease, as assessed by the Balance, Eyes, Face, Arm, Speech, Terrible Headache/Time to Call 911 (BE-FAST) test. <b><i>Results:</i></b> Among 1,906 patients with median age 72 years (interquartile range [IQR] 60–81), 53% were female with a median on-scene time of 15 min (IQR 12–19). C statistics for the interventions of mechanical thrombectomy, alteplase administration, computed tomography angiography, and perfusion imaging were 0.681, 0.643, and 0.680, respectively. The cut point for predicting these 3 interventions was confirmed to be LAMS ≥ 4. LAMS ≥ 4 had sensitivity 0.730 (0.661–0.790) and specificity 0.570 (0.539–0.601) for mechanical intervention (endovascular thrombectomy, coiling, or clipping) and relative risk of 2.98 (2.19–4.07) for in-hospital death. <b><i>Conclusions:</i></b> This real-world field study validates the LAMS as an effective tool for prehospital assessment of suspected strokes in determining transport decisions, with predictive validity for interventions performed.

Abstract TMP71: The Los Angeles Motor Scale - Atrial Fibrillation (LAMS-AF) Score is Superior to LAMS in Predicting Large Vessel Occlusion

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Priya Narwal ◽  
Andrew Chang ◽  
Brian Mac Grory ◽  
Mahesh Jayaraman ◽  
Ryan McTaggart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Los Angeles ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

scholarly journals 285 Predictive Value of the Los Angeles Motor Scale for Large Vessel Occlusion Strokes

2018 ◽  
Vol 72 (4) ◽  
pp. S112-S113
Author(s):  
P. Banerjee ◽  
L. Ganti ◽  
J. Rosario ◽  
M. Wallen ◽  
L. Dub ◽  
...  
Keyword(s):  
Los Angeles ◽  
Predictive Value ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

scholarly journals Los Angeles Motor Scale to Identify Large Vessel Occlusion

Stroke ◽  
2018 ◽  
Vol 49 (3) ◽  
pp. 565-572 ◽  
Author(s):  
Ali Reza Noorian ◽  
Nerses Sanossian ◽  
Kristina Shkirkova ◽  
David S. Liebeskind ◽  
Marc Eckstein ◽  
...  
Keyword(s):  
Los Angeles ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

Abstract TMP62: Utility of the Los Angeles Motor Scale to Identify Emergency Large Vessel Occlusion in Acute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Prasannna Tadi ◽  
Pranav Reddy ◽  
Sravanthi Pemmasani ◽  
Nasir Fakhri ◽  
Matthew Siket ◽  
...  
Keyword(s):  
Los Angeles ◽  
Positive Predictive Value ◽  
Acute Stroke ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Vessel Imaging ◽  
Los Angeles Motor Scale

Introduction: Stroke is a common medical emergency. The outcome depends upon access to stroke specialists, rapid scanning, assessment, and treatments. Identification of large vessel occlusion (LVO) is critical in the selection of patients for emergency embolectomy (clot removal) in patients with acute ischemic stroke. A pre-hospital stroke severity scale, such as the Los Angeles Motor Scale (LAMS) may have utility in selecting appropriate patients for CTA, while minimizing radiation exposure risk to the population as a whole. Methods: This was a retrospective analysis of 249 consecutive code stroke activations at a comprehensive stroke center during a 3.5 month period using a LAMS cutoff of ≥4 to trigger CTA acquisition. We determined the sensitivity, specificity, positive predictive value, and negative predictive value of using LAMS to detect large vessel occlusion (LVO). Gold standard was any vessel imaging within 24 hours. Inter-rater reliability of LAMS scoring was determined by blinded scoring of physical exam data from the chart by 3 neurovascular physicians. Results: There were 249 code stroke activations during the study period: 91 acute CTAs were recommended based on LAMS scoring. 20 large vessel occlusions were detected. 158 patients did not have a CTA acutely; none had a LVO during subsequent vessel imaging. The sensitivity is 100%, negative predictive value 100%, specificity 69%, positive predictive value 22% of the LAMS triage method. Inter-rater Reliability: Shrout-Fleiss pairwise weighted kappa coefficients between the three raters on LAMS scores were 0.67, 0.55, and 0.62. Kappa coefficients for pairs of raters when LAMS were dichotomized as <3 vs 4-5 were 0.64, 0.50, and 0.71. Clinically meaningful disagreements were evident. Conclusions: Accuracy and ease-of-use makes LAMS an ideal clinical tool to rapidly assess acute stroke patients for LVO and emergency mechanical thrombectomy. LAMS demonstrated excellent sensitivity in excluding patients who did not have a LVO. Appropriate training is required to ensure accuracy of LAMS scoring by providers.

Abstract TP34: Real World Efficacy of Endovascular Thrombectomy in Patients With Acute Cerebral Large Vessel Occlusion in Japan - First Report From RESCUE-Japan Registry 2

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Shinichi Yoshimura ◽  
Nobuyuki Sakai ◽  
Kazutaka Uchida ◽  
Masayuki Ezura ◽  
Yasushi Okada ◽  
...  
Keyword(s):  
Real World ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
First Report

Abstract 33: The Impact Transfer Status, Level of Stroke Center Certification, and Hospital Thrombectomy Volume on the Outcome of Acute Ischemic Stroke Patients with Emergent Large Vessel Occlusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason W Tarpley ◽  
Lindsay Lucas ◽  
Joseph T Ho ◽  
Renee Ovando ◽  
Elizabeth Baraban
Keyword(s):  
Large Vessel ◽  
Linear Regression Models ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Stroke Registry ◽  
Discharge Disposition ◽  
Stroke Center ◽  
The Right ◽  
The Impact

Introduction: Recent thrombectomy trials for emergent large vessel occlusion (ELVO) have spurred an international debate regarding the best way to get ELVO patients to the right centers quickly. Here we attempt to identify triage features associated with the best patient outcomes. Methods: A large, multi-hospital health system Get With The Guidelines stroke registry was used to identify patients >18 years old who had intra-arterial (IA) treatment of ELVO between January 2012 and June 2016. Primary outcomes were modified Rankin score (mRS) at discharge and discharge disposition. Generalized linear regression models were used to identify which of the variables on the figure’s Y-axis were related to the outcomes. Results: We identified 562 ELVO patients who received IA-treatment. Patients were more likely to have greater disability if they were treated at a PSC (AOR=3.14; p=.004), were a transfer (AOR = 5.18, p=.001), had a higher NIHSS score (AOR = 1.10; p<.001), were older (AOR=1.04; p=.003), or had longer Door to IA times (AOR = 1.01; p=.008). Compared to discharge to home, patients were more likely to be sent to hospice or expire if they were treated at a PSC (AOR=2.28; p=.021), were a transfer (AOR=2.39, p=.047), had a higher NIHSS (AOR=1.19; p<.001), were older (AOR = 1.06; <.001), or had longer Door to IA times (AOR = 1.01; p=.009). Patients were more likely to be sent to a SNF if they if they were a transfer (AOR = 2.70, p=.014), had a higher NIHSS score (AOR=1.13; p<.001), were older (AOR = 1.06; <.001), or had longer Door to IA times (AOR = 1.01; p=.029). Conclusions: Being treated locally rather than transferred, at a comprehensive rather than primary stroke center, and with shorter door to IA times were the strongest drivers of good outcome. Conversely, the annual IA treatment volume was not a driver of outcome.

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