Rapid Arterial oCclusion Evaluation (RACE) Scale for Stroke
Prehospital and emergency stroke severity scale to identify large vessel occlusion (LVO) stroke requiring thrombectomy. Validated as simple 5-item scale.
Score interpretation
RACE < 5 -- large vessel occlusion less likely; standard stroke pathway
→ Standard stroke pathway; activate stroke team; CT head and CT angiography per local protocol; thrombolysis if eligible (symptom onset < 4.5 hours, no contraindications); transfer to nearest stroke unit; NIHSS formal assessment on arrival; RACE < 5 does not exclude LVO -- do not delay IV thrombolysis for CT angiography once non-contrast CT has excluded haemorrhage.
RACE >= 5 -- large vessel occlusion likely; consider thrombectomy pathway
→ Immediate triage to thrombectomy-capable centre (comprehensive stroke centre); activate interventional neuroradiology team pre-arrival; CT head + CT angiography of head and neck immediately on arrival; IV alteplase if eligible (do not delay for thrombectomy preparation); mechanical thrombectomy if CTA confirms LVO in anterior or posterior circulation within 6 hours (up to 24 hours in selected patients with penumbra imaging); NIHSS assessment; glucose control (4-11 mmol/L target); BP below 185/110 mmHg before and below 180/105 mmHg during and for 24 hours after thrombolysis.
Interpretation bands for the RACE Scale. Apply clinical judgement and local guidance.
References
- Perez de la Ossa N et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke. 2014;45(1):87-91.
- ESO Guidelines for Management of Ischaemic Stroke. European Stroke Organisation. 2021.
Related
Curated clinical cross-links plus same-class fallbacks.
- Alteplase (Peripheral Arterial / DVT Use) · Thrombolytic — Catheter-Directed Thrombolysis / Peripheral Arterial Occlusion
- Streptokinase · Thrombolytic — Peripheral Arterial Occlusion / DVT (Historical)
- Selexipag · Pulmonary Arterial Hypertension
- Macitentan · Pulmonary Arterial Hypertension
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.