Abstract WP188: Feasibility of SCANME Tool in the Emergency Department to Enhance Hemorrhagic Stroke Recognition

Title: Feasibility of SCANME Tool in ED to Enhance Hemorrhagic Stroke Recognition Introduction: Rapid screening of patients for neurological symptoms is critical to initiate stroke treatment pathways in emergency departments (ED). Standard stroke screening tools such as BEFAST may miss non-specific symptoms such as headache, resulting in delays in diagnosis of hemorrhagic stroke. A recently proposed tool, SCANME (Figure 1), assesses red flag headache features, including sudden onset, severe intensity, seizure, worsening with position changes, altered mental status, focal neurological deficits, lack of relief with medication, and elevated blood pressure or temperature, to recognize possible hemorrhagic strokes. However, feasibility of implementing this tool in the ED setting has not been tested. Objectives: To evaluate the feasibility and effectiveness of using the SCANME screening tool to identify hemorrhagic strokes in the ED of a comprehensive stroke center. Methods: The SCANME tool was applied to patients presenting to the ED with chief complaint of worst headache of life or terrible headache. Patients received one point for each positive feature; a total score of 3 or more would trigger a stroke pathway activation for rapid imaging. Results: From July 2024-June 2025 SCANME was applied to 2,490 patients, 121 of those patients surveyed activated a code stroke. Of the 121 patients with an activated code stroke 18 patients were experiencing a hemorrhage. Conclusion: The implementation of SCANME was feasible and effective. As a result, we have increased our code stroke activation for hemorrhages from 54% in 2023 to 71% as of July 31st, 2025. We have decreased our Door to CT initiation from a median time of 46 minutes in 2023 to 18 minutes in 2025 as of July 31 st , 2025.