EMS Provider Preference Comparison Between the Pre-hospital ELVO Detection During Initial Care Transport (PREDICT) Scale and the Rapid Arterial Occlusion Evaluation (RACE) Scale: A Subanalysis of the PREDICT Study. (16th November 2020)

• Record Type: Journal Article
• Authors: Viacava, Enzo F; Cruz, Aurora S; Ugiliweneza, Beatrice; Dengzhi, Wang; White, Andrew; Khattar, Nicolas K; Gallimore, Bryan; Ding, Dale; Wolfe, Stacey Q; Heck, Donald; James, Robert F
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_356
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Pre-hospital identification of patients with large vessel occlusion (LVO) is critical in the timely triage of thrombectomy-eligible patients to comprehensive stroke centers. Emergency Medical Services (EMS) training is critical to the success of prehospital screening scales. METHODS: 86 EMS providers were trained on a secure, online application to perform and record the PREDICT-4 and RACE scales and complete a one-question survey on their preference. A chi-square and one-sample test of proportion was conducted. RESULTS: 86 EMS providers enrolled 250 subjects. 38 providers enrolled one subject and 48 enrolled ≥2. For all EMS providers with and without previous exposure to the RACE scale, 37.2% preferred the PREDICT 4-item scale and 62.8% preferred the RACE scale, P = . 018, 95%CI [27.7, 47.8 and 52.2, 72.2, respectively]. 49 providers (34.7%) without prior mere-exposure to the RACE scale preferred PREDICT-4 [95%CI 22.9, 48.6%] and 65.3% preferred RACE ( P = . 03, 95%CI [51.3, 77.0]). For providers who enrolled ≥2, on their first screening 41.6%, ( P = . 248, 95%CI [28.8, 55.7]) preferred PREDICT-4 and 58.3%, RACE. On their last screening, only 37.5%, ( P = . 08, 95%CI [25.2, 51.6]) preferred PREDICT-4. CONCLUSION: The PREDICT scale was found to be less preferable with EMS provider all-comers, which may be partially explained by mere-exposure cognitive bias, though this difference persisted in providers without prior exposure to either scale. In providers who enrolled multiple patients, there was a trend towards preference for RACE between their first and last screening.