Clinical utility of the RACE score for differentiating stroke from stroke mimics in the emergency department

 So really nothing objective at all. Here's a suggestion for fast analysis.

Like maybe these fast diagnosis options?

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds; February 2017 

Smart Brain-Wave Cap Recognises Stroke Before the Patient Reaches the Hospital

 October 2023

And then this to rule out a bleeder.

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017 

The Rapid Arterial oCclusion Evaluation (RACE) scale is a validated prehospital tool designed to identify Large Vessel Occlusion (LVO) in acute stroke patients. It scores five key neurological areas—facial palsy, arm motor function, leg motor function, gaze, and aphasia/agnosia—ranging from 0–9, with a score of (ge 5) indicating a high likelihood of LVO(So nothing objective in this at all!), aiding triage to comprehensive stroke centers

The latest here: 

Clinical utility of the RACE score for differentiating stroke from stroke mimics in the emergency department

• 

  Hatice Yelda Yildiz 1*

• K

  Kaan Gülcan 2

• S

  Süreyya Ece Kozbaǧ 2

• İ

  İrem Özürün 3

• Z

  Zeynep Demirkiran 4

• 

  Yakup Krespi 1

• 1. Department of Neurology, Faculty of Medicine, İstinye University, Istanbul, Türkiye

• 2. Fatih District Health Directorate, Fatih, Istanbul, Türkiye

Abstract

Objective: 

Rapid differentiation of true stroke from stroke mimics remains a major challenge during emergency department stroke evaluations. This study aimed to evaluate the clinical utility of the Rapid Arterial Occlusion Evaluation (RACE) score in distinguishing stroke from stroke mimics and identifying large vessel occlusion (LVO) in patients evaluated through an emergency department stroke activation workflow.

Materials and methods: 

This retrospective observational study analyzed routinely collected clinical data from consecutive adult patients evaluated through an emergency department stroke activation pathway. The RACE score was calculated at bedside as part of routine stroke workflow, and final diagnoses were established by vascular neurologists based on clinical evaluation and neuroimaging findings. Patients were classified as stroke or stroke mimic cases. The diagnostic performance of the RACE score for identifying LVO was assessed using receiver operating characteristic (ROC) curve analysis, and logistic regression was used to evaluate the association between RACE score and LVO.

Results: 

A total of 303 patients were included in the final analysis, of whom 133 (43.9%) were diagnosed with stroke and 170 (56.1%) were classified as stroke mimics. Patients with stroke were significantly older than those with stroke mimics (69.13 ± 12.59 vs. 61.67 ± 17.72 years, p = 0.001). The mean RACE score was significantly higher in stroke patients than in stroke mimics (3.15 ± 2.62 vs. 1.64 ± 1.91, p < 0.001), and RACE scores ≥5 were more frequent in stroke cases (30.8% vs. 8.8%, p < 0.001). LVO was identified in 46 patients (15.4%). Patients with LVO had significantly higher RACE scores than those without LVO (4.59 ± 2.63 vs. 1.85 ± 2.03, p < 0.001), and 56.5% of LVO cases had RACE scores ≥5. Logistic regression analysis showed that higher RACE scores were significantly associated with the presence of LVO [odds ratio (OR) 1.59, 95% Confidence Interval (CI) 1.38–1.83, p < 0.001].

Conclusion: 

The RACE score may provide clinically useful information for differentiating stroke from stroke mimics during emergency department evaluations. Higher RACE scores were associated with confirmed stroke and the presence of LVO, suggesting that the RACE score may serve as a practical adjunct to bedside neurological assessment within acute stroke workflows