Trial reportStroke2018
Los Angeles Motor Scale to Identify Large Vessel Occlusion: Prehospital Validation and Comparison With Other Screens.
Open access · bronzeAbstract readClinical Trial, Phase IIIComparative StudyMulticenter Study
In one paragraph
Trial report in Stroke, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 3 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 3 pooled it
11.2field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
50 citing papers in PubMed, 3 syntheses or guidelines pooled it, 129 citations in OpenAlex.
- Health Economic & Implementation Determinants of Prehospital Stroke Triage Tools: A Systematic Review.Journal of evaluation in clinical practice · 2026Pooled it
- Prehospital Large-Vessel Occlusion Stroke Detection Scales: A Pooled Individual Patient Data Analysis of 2 Prospective Cohorts.Neurology · 2025Pooled it
- Prehospital Prediction of Large Vessel Occlusion in Suspected Stroke Patients.Current atherosclerosis reports · 2018Pooled it
- Neurologic Improvement in Acute Cerebral Ischemia: Frequency, Magnitude, Predictors, and Clinical Outcomes.Neurology · 2023Trial
- Predicting stroke severity with a 3-min recording from the Muse portable EEG system for rapid diagnosis of stroke.Scientific reports · 2020Trial
- Long-term implementation of a prehospital severity scale for EMS triage of acute stroke: a real-world experience.Journal of neurointerventional surgery · 2020Trial
- Article
- Clinical Practice Guideline for the Prehospital Stage in Acute Stroke : I. Use of Emergency Medical Services Assessment Tools.Journal of Korean Neurosurgical Society · 2026Article
- Comparing RAMA-LVO with other Prehospital Large-Vessel Occlusion Prediction Scales in Suspected Acute Stroke; A Retrospective Cross-sectional Study.Archives of academic emergency medicine · 2026Article
- Sensitivity of a Qualitative 5-Element Cortical Sign Screen for Detecting Acute Basilar Artery Occlusion.Journal of the American College of Emergency Physicians open · 2025Article
- Large-Vessel Occlusion Stroke Knowledge and Training for Stroke Severity Assessment Among Emergency Medical Services Personnel in the United States.Stroke (Hoboken, N.J.) · 2025Article
- Telemedicine-Enabled Ambulances for Prehospital Acute Stroke Management: A Pilot Study.Mayo Clinic proceedings. Digital health · 2024Article
- A Two-Step Approach Using the National Health Institutes of Health Stroke Scale Assessed by Paramedics to Enhance Prehospital Stroke Detection: A Case Report and Concept Proposal.Journal of clinical medicine · 2024Article
- Implementation of a Thrombectomy Stroke Center Triage Program in New York City Emergency Medical Services.Stroke (Hoboken, N.J.) · 2024Article
- Comparison between different referral strategies for acute ischemic stroke patients in a hub-spoke emergency stroke network: a real-world experience in south-east Lazio.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024Article
- Rapid Arterial Occlusion Evaluation (RACE) Tool in Detecting Large Cerebral Vessel Occlusions; a Systematic Review and Meta-Analysis.Archives of academic emergency medicine · 2024Review
- Nationwide Trends in Reperfusion Therapy and Outcomes of Acute Ischemic Stroke According to Severity: The Japan Stroke Data Bank.Stroke (Hoboken, N.J.) · 2023Article
- Modeling the Decay in Probability of Receiving Endovascular Thrombectomy on the Basis of Time From Stroke Onset.Stroke (Hoboken, N.J.) · 2023Article
- Assessing the Relationship between LAMS and CT Perfusion Parameters in Acute Ischemic Stroke Secondary to Large Vessel Occlusion.Journal of clinical medicine · 2023Article
- What predicts large vessel occlusion in mild stroke patients?BMC neurology · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors at 8 institutions in 1 country.
Ali Reza NoorianFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.). alireza.noorian@kp.org.
Nerses SanossianFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Kristina ShkirkovaFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
David S LiebeskindFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Marc EcksteinFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Samuel J StrattonFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Franklin D PrattFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Robin ConwitFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Fiona ChatfieldFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Latisha K SharmaFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Lucas RestrepoFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Miguel Valdes-SueirasFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
May Kim-TenserFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Sidney StarkmanFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
Jeffrey L SaverFrom the Department of Neurology, Kaiser Permanente Orange County, Anaheim, CA (A.R.N.); Department of Neurology, University of Southern California, Los Angeles (N.S., M.K.-T.); Department of Emergency Medicine and Neurology (S.J.S., S.S.), Department of Emergency (F.D.P.), Department of Neurology (A.R.N., K.S., D.S.L., L.K.S., L.R., M.V.-S., J.L.S.), and Department of Biomathematics (J.G.), University of California, Los Angeles; Los Angeles EMS Agency, Orange County EMS Agency, Santa Ana, CA (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and Stanford University, CA (S.H.).
FAST-MAG Trial Investigators and Coordinators
Orange County Healthcare Agency · USStanford University · USUniversity of Southern California · USLos Angeles County Department of Public Health · USKaiser Permanente Anaheim Medical Center · USNational Institute of Neurological Disorders and Stroke · USNational Institutes of Health · USNew York City Fire Department · US
Funding
Field Administration of Stroke Therapy-Magnesium Trial (FAST-MAG)U01NS044364 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI SAVER, JEFFREY L · 2003 to 2013
$46.4MNINDS NIH HHS U01 NS044364
Abstract
background and purposePrehospital scales have been developed to identify patients with acute cerebral ischemia (ACI) because of large vessel occlusion (LVO) for direct routing to Comprehensive Stroke Centers (CSCs), but few have been validated in the prehospital setting, and their impact on routing of patients with intracranial hemorrhage has not been delineated. The purpose of this study was to validate the Los Angeles Motor Scale (LAMS) for LVO and CSC-appropriate (LVO ACI and intracranial hemorrhage patients) recognition and compare the LAMS to other scales.
methodsThe performance of the LAMS, administered prehospital by paramedics to consecutive ambulance trial patients, was assessed in identifying (1) LVOs among all patients with ACI and (2) CSC-appropriate patients among all suspected strokes. Additionally, the LAMS administered postarrival was compared concurrently with 6 other scales proposed for paramedic use and the full National Institutes of Health Stroke Scale.
resultsAmong 94 patients, age was 70 (±13) and 49% female. Final diagnoses were ACI in 76% (because of LVO in 48% and non-LVO in 28%), intracranial hemorrhage in 19%, and neurovascular mimic in 5%. The LAMS administered by paramedics in the field performed moderately well in identifying LVO among patients with ACI (C statistic, 0.79; accuracy, 0.72) and CSC-appropriate among all suspected stroke transports (C statistic, 0.80; accuracy, 0.72). When concurrently performed in the emergency department postarrival, the LAMS showed comparable or better accuracy versus the 7 comparator scales, for LVO among ACI (accuracies LAMS, 0.70; other scales, 0.62-0.68) and CSC-appropriate (accuracies LAMS, 0.73; other scales, 0.56-0.73).
conclusionsThe LAMS performed in the field by paramedics identifies LVO and CSC-appropriate patients with good accuracy. The LAMS performs comparably or better than more extended prehospital scales and the full National Institutes of Health Stroke Scale.
Indexed as
Severity of Illness IndexAgedAged, 80 and overBrain IschemiaFemaleHumansIntracranial HemorrhagesMaleMiddle AgedStrokeambulancesbrain ischemiacerebral hemorrhagethrombectomytriage
Identifiers
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