Today we will review the S-LAMS score for suspected acute strokes!
A notification comes in --- the nurse tells you that a suspected LVO stroke patient is coming in and shouts out a random number
EMS in NYC utilize the Stratified Los Angeles Motor Scale Score or S-LAMS in the field to help determine where to transport a potential stroke patient. The last thing you’d want is for this type of patient to end up at a facility without stroke capabilities!
The LAMS is a validated 3-item prehospital scoring tool derived from the motor exam components of the Los Angeles Prehospital Stroke Screen (LAPSS). It was designed to rapidly quantify stroke severity in the prehospital setting.
Although other scores that are more comprehensive, the LAMS is a much simpler assessment tool that takes only 20-30 seconds to complete, making it well-suited for prehospital or triage settings. It correlates strongly with the full NIHSS (gold standard) and predicts long-term functional outcomes following stroke events.
Rapid access to time-sensitive interventions such as thrombolysis and endovascular therapy (EVT) for eligible patients is directly linked with improved long-term neurological outcomes for stroke patients.
LAMS ≥4 has a sensitivity of 81% and specificity of 89% for predicting large vessel occlusion (LVO).
Here is how it is calculated:
FACIAL DROOP
Absent – 0
Present – +1
ARM DRIFT
Absent – 0
Drifts down – +1
Falls rapidly – +2
GRIP STRENGTH
Absent – 0
Weak grip – +1
No grip – +2
If the patient has a NYC S-LAMS score of <3, paramedics will transport to the closest appropriate Primary Stroke Center (can give TPA, essentially).
If the patient has a NYC S-LAMS score of >4, paramedics will contact OLMC for transport decision to the closest Comprehensive Stroke Center (can do thrombectomy), unless exclusion criteria are met:
· Total time from onset of patient’s symptoms to EMS patient contact is greater than 5 (five) hours
· Patient is wheelchair or bed-bound
· Seizure is cause of symptoms
· Loss of Consciousness (LOC)
· Trauma is cause of symptoms
· Transport time to Thrombectomy Stroke Center is > 30 minutes
REFERENCES
https://nasemso.org/wp-content/uploads/NYS-Stroke-Centers-2.pdf
Llanes, J. N., Kidwell, C. S., Starkman, S., Leary, M. C., Eckstein, M., & Saver, J. L. (2004). The Los Angeles Motor Scale (LAMS): a new measure to characterize stroke severity in the field. Prehospital emergency care, 8(1), 46–50. https://doi.org/10.1080/312703002806
Harris, D., Hall, C., Lobay, K., McRae, A., Monroe, T., Perry, J. J., Shearing, A., Wollam, G., Goddard, T., & Lang, E. (2015). Canadian Association of Emergency Physicians position statement on acute ischemic stroke. CJEM, 17(2), 217–226. https://doi.org/10.1017/cem.2015.26
Nazliel B, Starkman S, Liebeskind DS, Ovbiagele B, Kim D, Sanossian N, Ali L, Buck B, Villablanca P, Vinuela F, Duckwiler G, Jahan R, Saver JL. A brief prehospital stroke severity scale identifies ischemic stroke patients harboring persisting large arterial occlusions. Stroke. 2008 Aug;39(8):2264-7. doi: 10.1161/STROKEAHA.107.508127. Epub 2008 Jun 12. PMID: 18556587; PMCID: PMC2743906.