Optimizing Acute Ischemic Stroke Care: Evaluating Emergency Stroke Code Activation and Thrombolytic Therapy in East Azerbaijan Province

Background: Stroke remains a significant global health challenge, contributing to mortality and disability burdens. Optimizing stroke care involves understanding the complexities of in-hospital management, especially in regions like East Azerbaijan Province, where stroke incidence is high. Objectives: This study evaluates the effectiveness of Emergency Stroke Code (ESC) activation and thrombolytic therapy in acute ischemic stroke care at Imam Reza Hospital, Tabriz, a referral center. Methods: A cross-sectional study was carried out between April 2021 and March 2022, including patients with activated ESC or receiving thrombolysis at Imam Reza Hospital, Tabriz. Data on patient demographics, risk factors, time intervals, thrombolysis administration, adverse events, and outcomes were collected and analyzed using SPSS software. Results: Among 748 acute stroke patients, 165 received thrombolysis, with 117 having ESC activation. The main reasons for not administering tissue plasminogen activator (tPA) in patients with ESC code activation included mild symptoms (23.6%), exceeding thrombolysis time (14.8%), and hemorrhagic stroke (10.4%). Pre-hospital ESC activation significantly reduced time intervals from hospital arrival to CT-scan and tPA injection (P < 0.001). The incidence of intracranial hemorrhage was 6.7% overall, with rare systemic bleeding (0.6%). Pre-hospital notification did not show significant changes in the National Institutes of Health Stroke Scale (NIHSS) or Modified Rankin Scale (MRS) scores. Conclusions: While ESC activation streamlines in-hospital processes, it alone may not improve clinical outcomes without efficient out-of-hospital systems. Pre-hospital communication systems like ESC can aid in reducing in-hospital processing time for thrombolysis but must be coupled with efforts to enhance early diagnosis and efficient dispatch systems to optimize stroke care.