Rapid Arterial oCclusion Evaluation Scale

R.A.C.E

 

Facial Palsy

 

Ask patient to show their teeth (smile)

 

Absent (symmetrical movement)

= 0

Mild (slight asymmetrical)

= 1

Moderate to severe (completely asymmetrical)

= 2

 

Arm Motor Function

 

Extending the arm of patient

90° (if sitting) or 45° (if supine)

 

Normal to Mild (limb upheld more than 10 seconds)

= 0

Moderate (limb upheld less than 10 seconds)

= 1

Severe (patient unable to raise arm against gravity)

= 2

 

Leg Motor Function

 

Extending the leg of the patient 30° (in supine)

 

Normal to Mild (limb upheld more than 5 seconds)

= 0

Moderate (limb upheld less than 5 seconds)

= 1

Severe (patient unable to raise arm against gravity)

= 2

 

Head & Gaze Deviation

 

Observe eyes and head deviation to one side

 

Absent (eye movements to both sides were possible and no head deviation was observed)

= 0

Present (eyes and head deviation to one side was observed)

= 1

 

Aphasia (R side)

 

Difficulty understanding spoken or written words.

Ask patient to follow two simple commands:

  1. Close your eyes
  2. Make a fist.

 

Normal (performs both tasks requested correctly)

= 0

Moderate (performs only 1 of 2 tasks requested correctly) = 1

Severe (cannot perform tasks requested correctly)

= 2

 

Agnosia (L side)

 

Inability to recognize familiar objects.

Ask patient:

  1. “Whose arm is this? (while 0-2 showing the affected arm)
  2. “Can you move your arm?”

 

Normal (recognizes arm and attempts to move arm)

= 0

Moderate (does not recognize arm or is unaware of arm) = 1

Severe (does not recognize arm and is unaware of arm)

= 2

 

High likelihood of LVO with a score greater than or equal to 5

 

R.A.C.E. is based on an abbreviated version of the NIHSS, the “gold standard” for evaluating stroke victims.

 

  • The maximum score is 9 (not 11) because the evaluation is done on the left or right side not both simultaneously.
  • The R.A.C.E. is a 5 of 6 item scale. The last item is 1 of 2 based on which side the patient has deficits on previous scale items.
  • The NIHSS equivalent is provided for the benefit of receiving facility. The NIHSS score may be higher than the "snap shot” provided in the R.A.C.E. because the NIHSS evaluates additional areas not covered in the R.A.C.E. which is short by design for EMS field use.
  • The R.A.C.E. is a universal quantitative tool that is needed to determine the severity of a stroke and to identify strokes with large vessel occlusions (LVO) which would benefit going to a Comprehensive Stroke Center (CSC). This is similar to a 12-lead EKG identifying a STEMI and being transported to a PCI Cardiac Center for intervention.
  • The Cincinnati (CPSS), the F.A.S.T., the Miami (MENDS), the Los Angeles (LAPSS) stroke scales are good scales that offer high degree of sensitivity for strokes, but they are all qualitative scores (positive or negative) and not quantitative (severity).
  • The cut-score of 4 is based on the significant global accuracy of R.A.C.E. predicting an LVO and its close correlation to the NIHSS.
  • A free online tool is available to calculate a R.A.C.E. score at: http://www.rccc.eu/race/RACEen.html
  • For the study behind the R.A.C.E. see
  • http://stroke.ahajournals.org/content/45/1/87.full