Abstract WP105: Accuracy of Code Stroke Alerts In The Emergency Department, A Single Comprehensive Stroke Center Experience

Background: Acute Ischemic Stroke (AIS) is a neurological emergency associated with significant morbidity and mortality. Clinical screening protocols like BE-FAST (Balance, Eyes, Face, Arms, Speech, Time) have been developed to identify potential stroke patients to expedite emergent evaluation and treatment. In our center, BE-FAST is used by emergency room (ER) providers to activate code stroke alerts. We retrospectively analyzed a cohort of ER code stroke activations to assess the accuracy of code stroke alerts, for process improvement and resource utilization review. Methods: All ER code stroke activations during March 2025 were analyzed. Code strokes were activated by ER providers using the BE-FAST criteria and via pre-hospital Emergency Medical Services (EMS) using multiple EMS algorithms. Data was obtained by retrospective chart review using electronic medical records. Demographics, means of arrival, and presenting clinical symptoms were collected. Final diagnosis was obtained via clinical documentation and/or imaging studies (MRI/CT). The percentage of code stroke activations with a final diagnosis of AIS, TIA and ICH was calculated. Results: A total of 200 ER code stroke activations were noted during the month. The percentage of patients with a final diagnosis of AIS was 24.5%, TIA 10%, and ICH 2%. EMS driven pre-hospital activations were more accurate than ER activations for the diagnosis of AIS, 46.5% vs.15.4%, respectively. Of those with clinical symptoms of isolated dizziness (15.8%), none had a final diagnosis of AIS, ICH, or TIA. The most common stroke mimics were peripheral vestibulopathy (14.9%), seizure (8.9%), migraine (8.4%), peripheral neuropathy (7.4%), and delirium (6.9%). The majority (94%) of code stroke alerts received a CTA. Acute IV thrombolysis was administered to 5.5% and 4.5% received emergent mechanical thrombectomy. Conclusions: The combined diagnosis of AIS and ICH was 27% for all ER activations (EMS + ER). From the viewpoint of the stroke program, this represents a high false activation rate burdening healthcare resources with unnecessary testing. Further education and collaboration is needed to optimize ER screening and activation protocols.