ABSTRACT NUMBER: ESOC2026A207 PRE-HOSPITAL TRIAGE SYSTEMS FOR LARGE VESSEL OCCLUSION STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF DIAGNOSTIC ACCURACY AND CLINICAL IMPACT

Abstract Background and aims Rapid identification of large vessel occlusion (LVO) during pre-hospital assessment is essential to shorten time to reperfusion and improve outcomes. Multiple triage tools have been developed for use by emergency medical services, yet their comparative accuracy and impact on treatment pathways remain uncertain. Aim To evaluate the diagnostic accuracy and clinical implications of pre-hospital LVO triage scales compared with standard assessment in adults with suspected acute stroke. Methods A systematic review and meta-analysis were performed according to PRISMA guidelines. Searches of PubMed, Scopus, Web of Science, and the Cochrane Library identified prospective and retrospective studies assessing pre-hospital LVO tools against vascular imaging. Data extracted included sensitivity, specificity, area under the curve (AUC), time metrics, and rates of direct transport to thrombectomy-capable centres. Random-effects models generated pooled diagnostic estimates. Results Twenty-one studies encompassing 18,743 patients met inclusion criteria. Across all tools, pooled sensitivity for LVO detection was 0.78 (95% CI: 0.72–0.84; I2=89%) and pooled specificity was 0.72 (95% CI: 0.65–0.78; I2=86%). Among individual scales, the highest AUCs were observed for the FAST-ED (0.84) and RACE (0.82) scores. Use of structured triage increased direct transport to thrombectomy-capable centres (OR: 1.68; 95% CI: 1.29–2.21; I2=41%) and reduced onset-to-arterial puncture time by a mean of 34 minutes (95% CI: 21–47; I2=76%). No significant difference in rates of thrombolysis omission was identified. Conclusions Pre-hospital LVO triage scales improve diagnostic accuracy and streamline routing to specialist centres, supporting their integration into regional stroke pathways. Conflict of interest all authors have has nothing to disclose