Abstract WP064: Increased Stroke Alert Volume Does Not Correlate with Higher Thrombolysis Rates

Introduction: Acute ischemic stroke is a time-sensitive neurologic emergency that requires prompt identification and intervention. With the expansion of hyperacute stroke treatment protocols, there has been a broadening of criteria for activating stroke alerts to minimize the risk of a missed stroke diagnosis. This paradigm shift has led to an increase in the number of stroke alerts. We sought to determine whether this rise in stroke alert frequency has translated into increased thrombolysis utilization. Methods: Using paging records, we captured every stroke alert between 2021 and 2023 at our 505 bed academic Joint Commission certified Comprehensive Stroke Center. Stroke alerts were categorized as prehospital, emergency department (ED), or inpatient. Thrombolysis data was obtained from annual reports. Intra-arterial thrombolysis reflected both mechanical and pharmacologic endovascular stroke treatments. Yearly thrombolysis rates were calculated by dividing total thrombolysis cases by the number of stroke alerts. Results: Between 2021 and 2023, the total number of stroke alerts increased from 1,087 in 2021, to 1,180 in 2022, and 1,255 in 2023. As shown in Figure 1, the proportion of prehospital alerts rose from 26.8% in 2021 to 34.9% in 2023 while ED-initiated alerts decreased from 45.4% in 2021 to 38.6% in 2023 ( p <0.001). Inpatient alerts remained stable over time. Thrombolysis data are shown in Table 1. There were 199 thrombolysis cases in 2021, 172 in 2022, and 174 in 2023. The thrombolysis rate decreased from 18.3% in 2021 to 13.9% in 2023. Conclusion: From 2021 to 2023 there was a 13% increase in the number of stroke alerts. The frequency of prehospital stroke alerts increased while ED stroke alerts decreased. The increased number of stroke alerts did not correspond to an increase in thrombolysis treatments. In fact, the thrombolysis rate decreased by 24% from 2021 to 2023. These findings suggest that expanded stroke alert criteria may increase alert volume without improving treatment rates, potentially impacting resource utilization and clinical workflow efficiency.