Abstract TP264: Analysis of Emergency Department Code Stroke Activations at a Large County Hospital: Real World Experience

• Published in: Stroke (1970) 2020-02, Vol.51 (Suppl_1)
• Main Authors: Cheung, Ryan, Magadan, Alejandro A
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.51.suppl_1.TP264

Abstract only Introduction: Code strokes are activated to rapidly mobilize hospital resources directed at stroke care. Activations for non-strokes and stroke mimics can divert attention away from patients with acute stroke or delay care of other medical emergencies. There is a drive to reduce door to treatment times in acute ischemic stroke (AIS) without a universal triage method to accurately recognize stroke. We looked at the most common reasons for activation of a code stroke in a quality improvement effort to increase the yield of correctly identifying AIS treatment. Methods: Retrospective review of prospectively collected emergency department (ED) code stroke activations between January - December 2018 at our institution. Reasons for code stroke activations, patient demographics, exam and MRI findings, and discharge and neurologist diagnoses were reviewed. Results: A total of 523 patients were activated as an ED code stroke. One hundred forty (26.8%) were discharged with a cerebrovascular-related diagnosis (20.1% AIS, 1.2% TIA, and 5.6% ICH). The average age of all acute cerebrovascular pathology is 61.5 years and the gender were found to be 57.1% male. The non-stroke group had an average age of 51.8 years and were 44.1% male. The average NIHSS of the entire cerebrovascular cohort was 9.1 (7.8 in AIS, 15.1 in ICH) compared with 4.6 in the non-stroke group. The most frequent non-stroke diagnosis was related to non-neurologic medical emergencies (25.3%), headaches and migraine (14.6%), psychiatric diagnoses (14.1%), recrudescence of prior symptoms (9.1%), and other neurologic emergencies (8.4%). Conclusion: In an era of increased treatment expectations, accurate detection of AIS is key. Current activation criteria and screening tools have a low sensitivity and specificity for AIS. They are often complex for the non-neurologist and inconsistently applied during a code stroke. In conclusion, an overwhelming majority of code strokes are not related to AIS and represent other non-neurologic medical emergencies. A simpler more accurate triage method is needed.