UMEM Educational Pearls

Category: Neurology

Title: Prehospital Stroke Scales for Large Vessel Occlusion

Keywords: stroke, prehospital, large vessel occlusion, NIHSS, RACE, LAMS, VAN (PubMed Search)

Posted: 3/14/2018 by WanTsu Wendy Chang, MD (Updated: 7/17/2024)
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  • A recent systematic review evaluated the diagnostic accuracy of 19 prehospital stroke scales.
  • Arm motor strength is the most frequently evaluated item by the scales (15/19), followed by gaze (13/19) and language (13/19).
  • Only 4 scales (RACE, LAMS, VAN, sNIHSS-EMS) were performed by paramedics in their original studies.
  • The NIHSS, LAMS, and VAN appear to have better results in predicting large vessel occlusion.
  • The presence of hemineglect, a sign of cortical involvement, improved the accuracy of the scale.


  • There is growing evidence for mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion.
  • Identification of potential eligible patients begin in the prehospital setting in order for preferential transport of these patients to comprehensive stroke centers.
  • Selected prehospital stroke scales:
    • RACE = Rapid Arterial Occlusion Evaluation Scale
    • LAMS = Los Angeles Motor Scale
    • VAN = Stroke Vision, Aphasia, Neglect Assessment
    • NIHSS = National Institute of Health Stroke Scale


  • Vidale S, Agostini E. Prehospital stroke scales and large vessel occlusion: A systematic review. Acta Neurol Scand. 2018 Feb 11. [Epub ahead of print]

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