Background: Prehospital stroke triage scores aim to identify LVO patients who benefit from direct transport to high-level stroke centers for EVT by bypassing primary stroke centers. Patients with ICH may benefit from direct transport to high-level centers for neurologic intensive care and hematoma evacuation. Lobar ICH patients may particularly benefit as randomized clinical trial data suggest hematoma evacuation is more effective in these patients. We determined the ability of prehospital LVO triage scores to identify ICH patients and to discriminate lobar from non-lobar ICH. Methods: We identified ICH cases presenting to the ED in Greater Cincinnati/Northern Kentucky in 2005, 2010, and 2015. Cases were identified by ICD codes (ICD9 430-438, ICD10 G45-46, H34.11-12, I60-69), clinical data was extracted by a research nurse and adjudicated by physicians. The CSTAT and RACE scores were abstracted from the NIHSS. We calculated the proportion of ICH patients with a CSTAT ≥ 2 and a RACE ≥ 5, cut-offs used to bypass primary stroke centers, and the scores’ ability to distinguish lobar from non-lobar ICH. Results: We identified 904 ICH patients (median age 72, 54% female, 25% Black). CSTAT was ≥ 2 in 45% of all ICH patients while 27% had a RACE ≥ 5. These score cut-offs identified patients with more severe deficits (Table). Among patients with lobar ICH (n=391), 44% had a CSTAT ≥ 2 and 27% had a RACE ≥ 5. Results were similar for non-lobar ICH (n=473, 45% CSTAT ≥ 2 and 26% RACE ≥ 5). Both scores performed poorly in differentiating lobar from non-lobar ICH (CSTAT ≥ 2: sensitivity 0.44, specificity 0.55, AUC 0.52; RACE ≥ 5: sensitivity 0.27, specificity 0.74, AUC 0.53). Conclusion: Prehospital LVO triage scores identified fewer than half of all ICH patients and did not discriminate between lobar and non-lobar ICH. New prehospital triage scores are needed to identify all ICH patients, or perhaps ICH subgroups, along with LVO patients who benefit from direct transport to high-level stroke centers.
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