Abstract WP438: The Los Angeles Motor Scale (LAMS) is a Validated and Robust Tool for Paramedic Assessment of Stroke Severity in the Field

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Joon-Tae Kim ◽  
Pil-Wook Chung ◽  
Sidney Starkman ◽  
Nerses Sanossian ◽  
Samuel Stratton ◽  
...  
Keyword(s):  
Los Angeles ◽  
Cerebrovascular Disease ◽  
Predictive Validity ◽  
Functional Outcomes ◽  
Stroke Severity ◽  
Divergent Validity ◽  
Valid Measure ◽  
Hospital Arrival ◽  
Los Angeles Motor Scale ◽  
Rapid Quantification

Introduction: A simple, validated paramedic assessment of prehospital stroke severity would permit selective routing of more severe patients to Comprehensive Stroke Centers and a critical pretreatment deficit score in RCTs of prehospital intervention. The Los Angeles Motor Scale is a 3-item, 0-10 point motor stroke deficit scale developed for prehospital and ED use. Hypothesis: We assessed the hypothesis that the LAMS could be a valid tool for assessment of stroke severity on hospital arrival (HA) and prediction of 90D functional outcome. Methods: Among consecutive patients in the multi-ambulance, multi-hospital FAST-MAG trial, we assessed the predictive validity, concurrent, and divergent validity of the LAMS. Results: Among all 1,632 acute cerebrovascular disease patients in FAST-MAG, time from last known well (LKW) to prehospital LAMS exam was 30 mins (IQR 20 to 50), and from LKW to HA exam 147 mins (119-180). Median prehospital LAMS score was 4 (IQR 3 to 5). Concurrently performed HA LAMS and HA NIHSS correlated strongly, r=0.85, HA LAMS and GCS less so, r=0.62, as expected. Predictive validity of the prehospital LAMS was excellent. LAMS scores were higher in patients with dependency or death (mRS 0-3) at 90D, 4.2 vs 3.4, p <0.0001, and in patients with death by 90D, 4.3 vs 3.7, p<0.0001. The HA LAMS correlated with 90D mRS nearly as well as the concurrent HA NIHSS, r=0.55 vs 0.62. Each step on the LAMS scale was associated with a substantial shift to a worse distribution (Figure). Conclusion: The LAMS scale is a valid measure for paramedic use, permitting rapid quantification of prehospital stroke severity and predicting functional outcomes with accuracy comparable to the full NIH Stroke Scale.

scholarly journals Field Validation of the Los Angeles Motor Scale as a Tool for Paramedic Assessment of Stroke Severity

Stroke ◽  
2017 ◽  
Vol 48 (2) ◽  
pp. 298-306 ◽  
Author(s):  
Joon-Tae Kim ◽  
Pil-Wook Chung ◽  
Sidney Starkman ◽  
Nerses Sanossian ◽  
Samuel J. Stratton ◽  
...  
Keyword(s):  
Los Angeles ◽  
Stroke Severity ◽  
Field Validation ◽  
Los Angeles Motor Scale

Abstract 118: Paramedic-Administered Los Angeles Motor Scale identifies Ischemic Stroke with Large Vessel Occlusion and Intracranial Hemorrhage for Routing to Comprehensive Stroke Centers and Compares Favorably to Other Screening Methods

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ali Reza Noorian ◽  
Nerses Sanossian ◽  
Kristina Shkirkova ◽  
David S Liebeskind ◽  
Marc Eckstein ◽  
...  
Keyword(s):  
Los Angeles ◽  
Intracranial Hemorrhage ◽  
Screening Methods ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Hospital Arrival ◽  
Academic Center ◽  
Acute Cerebral Ischemia ◽  
Los Angeles Motor Scale ◽  
Better Than

Background: Considering the recent advances in endovascular thrombectomy and advances in neurocritical care of patients with intracranial hemorrhage (ICH), there is an urgent need to develop tools for paramedics to identify patients likely to benefit from direct routing to comprehensive stroke centers (CSC). We report prospective validation of the Los Angeles Motor Scale (LAMS) performed by paramedics in the field, and compare its performance with other proposed prehospital LVO-identification scales. Methods: We analyzed all subjects enrolled in the NIH Field Administration of Stroke Therapy -Magnesium (FAST-MAG) trial transported directly to an academic center with a policy of performing immediate CTA or MRA imaging for all likely strokes. Prehospital LAMS was performed by paramedics prior to field enrollment. Hospital arrival (HA) LAMS and NIHSS were performed by trained study nurses after ED arrival. RACE, PASS, and 3i SS scales were calculated from NIHSS items. LVO in a proximal cerebral artery (ICA, MCA M1 & M2, Vertebral, Basilar and PCA P1 & 2) was determined by 3 vascular neurologists with expertise in neuroimaging. An LVO or ICH were considered as CSC appropriate patients. Results: Among 94 patients, age was 68 (±13) and 49% were female. Final diagnoses were acute cerebral ischemia in 71 (76%), intracranial hemorrhage in 18 (19%), mimic in 5 (5%). Overall, 48 patients (68%) had LVO, including MCA (30), ICA (14), basilar (1), vertebral (1) and PCA (2), and 66 (70%) were CSC-appropriate (LVO or ICH). In prediction of LVO, prehospital LAMS had the highest sensitivity (71%) and moderate specificity (54%). 3i-SS had the highest specificity (83%) but lowest sensitivity (40%). In prediction of CSC-appropriate patients, prehospital LAMS had the highest sensitivity (69%) and 3i-SS had the highest specificity (93%) but lowest sensitivity (37%). When comparing receiver operating curves, PM LAMS had AUC of 0.761, HA RACE 0.752, HA 3i SS 0.732, and HA PASS 0.712. Conclusions: Prehospital LAMS score of 4 or higher identified CSC-appropriate patients with good sensitivity and moderate specificity, and performed similar to or better than other proposed scales. LAMS is easy to administer and reproducible, and widely used currently by paramedics nationwide.

Abstract TP242: The Los Angeles Motor Scale Outperforms the Vision, Aphasia, Neglect Test as a Prehospital Stroke Scale

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tej G Stead ◽  
Latha Ganti ◽  
Rohan Mangal ◽  
Paul Banerjee
Keyword(s):  
Los Angeles ◽  
P Values ◽  
Hospital Arrival ◽  
Exact Test ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Los Angeles Motor Scale ◽  
The Cost ◽  
Mechanical Intervention ◽  
Higher Sensitivity

Introduction: In the prehospital setting, it is important to identify which patients need to be sent to a comprehensive stroke center. Methods: This IRB-approved prospective study included all patients transported for stroke by our EMS system from December 2018-May 2019. Patients were administered the Los Angeles Motor Scale (LAMS) and vision, aphasia, neglect (VAN) test by paramedics prior to hospital arrival. LAMS 4 or 5 was considered high for the purposes of our study. Patients were considered VAN positive if they were deficient in any of the three areas it tests. Results: Our cohort (n=480) was 50% male. Median age was 72, IQR 62-81 and range 13-108 years. The LAMS/VAN breakdown (n=378 patients who received both) was as follows: Low LAMS/Negative VAN: 32% High LAMS/Negative VAN: 10% Low LAMS/Positive VAN: 38% High LAMS/Positive VAN: 20% 68% of patients had either high LAMS or positive VAN. 26% received CTA perfusion imaging, 14% received tPA, and 7% received mechanical intervention. 9% were hemorrhagic strokes, 43% ischemic, and 11% TIAs. The median National Institutes of Stroke Score (NIHSS) at hospital arrival was 6, with IQR 2-13 and range 0-36. 50% of patients were discharged home and 5% expired. Table 1: relative risk (if applicable) and p-values associated with certain outcome-scale combinations, calculated using Fisher’s exact test or Wilcoxon’s rank-sum test (NS = not significant). In predicting mechanical intervention, LAMS had sensitivity 87% and specificity 72%, VAN had sensitivity 73% and specificity 41%, LAMS or VAN had sensitivity 96% and specificity 31%, LAMS and VAN had sensitivity 62% and specificity 82%. Conclusions: The LAMS is more effective than the VAN for general prehospital usage. Combining the two scales results in higher sensitivity at the cost of specificity in predicting mechanical intervention, which may be useful so that all potentially eligible patients for mechanical intervention can be sent to a comprehensive stroke center.

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.

scholarly journals Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Stefanie Behnke ◽  
Thomas Schlechtriemen ◽  
Andreas Binder ◽  
Monika Bachhuber ◽  
Mark Becker ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Stroke ◽  
Unsolved Problem ◽  
Standard Operating Procedure ◽  
Stroke Management ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Standard Operating ◽  
Los Angeles Motor Scale ◽  
Triage Decisions

Abstract Background The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy. Methods Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics. Results In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0–79.5%) and a specificity of 84.9% (95%-CI: 82.6–87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4–26.5%); specificity, 100% (95%-CI: 100–100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1–78.0%) and a specificity of 83.5% (95%-CI: 81.0–86.0%). Conclusions State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.

scholarly journals Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke

2021 ◽  
pp. 154596832110329
Author(s):  
Margaret J. Moore ◽  
Kathleen Vancleef ◽  
M. Jane Riddoch ◽  
Celine R. Gillebert ◽  
Nele Demeyere
Keyword(s):  
Functional Outcomes ◽  
Stroke Severity ◽  
Visuospatial Neglect ◽  
Recovery Pattern ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Significant Difference ◽  
Initial Severity

Background/Objective. This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes after 6 months post-stroke. Methods. This study presents a secondary cohort study of acute and 6-month follow-up data from 400 stroke survivors who completed the Oxford Cognitive Screen’s Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results. Overall, 98/142 (69%) neglect cases recovered by follow-up, and there was no significant difference in the persistence of egocentric/allocentric (X2 [1] = .66 and P = .418) or left/right neglect (X2 [2] = .781 and P = .677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F [9,300] = 4.742, P < .001 and adjusted R2 = .098). Conclusions. Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes over and above stroke severity alone.

Prestroke statin use enhances collateralization in acute ischemic stroke patients

2020 ◽  
Vol 38 (4) ◽  
pp. 311-321
Author(s):  
Jiaying Zhu ◽  
Mengmeng Ma ◽  
Jinghuan Fang ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Statin Therapy ◽  
Cerebral Artery ◽  
Functional Outcomes ◽  
Collateral Circulation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

scholarly journals Role of Acute Lesion Topography in Initial Ischemic Stroke Severity and Long-Term Functional Outcomes

Stroke ◽  
2015 ◽  
Vol 46 (9) ◽  
pp. 2438-2444 ◽  
Author(s):  
Ona Wu ◽  
Lisa Cloonan ◽  
Steven J.T. Mocking ◽  
Mark J.R.J. Bouts ◽  
William A. Copen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcomes ◽  
Stroke Severity ◽  
Acute Lesion ◽  
Lesion Topography

Low-dose statin pretreatment reduces stroke severity and improves functional outcomes

2019 ◽  
Vol 266 (12) ◽  
pp. 2970-2978 ◽  
Author(s):  
Shuju Dong ◽  
Jian Guo ◽  
Jinghuan Fang ◽  
Ye Hong ◽  
Shuhui Cui ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Low Dose ◽  
Stroke Severity
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