Abstract
Objective: To assess whether a prehospital Los Angeles motor scale (LAMS) of 4 or more predicts intervention for acute stroke.
Background: With mechanical thrombectomy for large vessel occlusions (LVO) strokes becoming more widespread, there is increased onus on prehospital personnel to identify LVOs, as this could influence their decision to preferentially transport LVO strokes to a comprehensive stroke center. Thus, having a prehospital tool that can accurately predict intervention is important.
Design/Methods: Data from all stroke transports to a comprehensive stroke center from January 1, 2018 to October 1, 2018 were abstracted from our IRB approved prehospital research registry. Data abstracted included demographics such as age and gender, prehospital variables such as blood pressure, LAMS and Rankin scores, and outcomes including whether the patient received advanced neuroimaging, intravenous tPA or mechanical thrombectomy (MT) at the receiving facility.
Results: There were 129 patients who had a LAMS score of 4 or 5, and they were significantly more likely to be an acute ischemic stroke rather than an intracranial hemorrhage or TIA (P<0.0001). The median NIHSS at hospital arrival was 8, with an IQR of 2–16.
Of these 129, 21% received tPA compared to 3% who had a lower LAMS (P<0.0001). Having a LAMS of 4 or 5 was also significantly associated with getting mechanical thrombectomy (36% vs. 12%, P<0.0001), and a higher NIHSS at hospital arrival. These results retained statistical significance after adjusting for age, gender and field mean arterial pressure (MAP). The median age, IQR and gender was similar between those who had a LAMS or 4 or 5 or less (P=NS).
Conclusions: The LAMS is a powerful prehospital predictor of intervention for acute stroke.
Disclosure: Dr. Stead has nothing to disclose. Dr. Banerjee has nothing to disclose. Dr. Ganti has received personal compensation in an editorial capacity for Springer International Journal of Emergency Medicine.
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