Abstract WP195: Assessing the Accuracy of Stroke Alerts at University of Colorado Hospital

Objective: Stroke alerts require rapid mobilization of valuable and limited resources. The objective of this quality improvement study was to evaluate the characteristics and accuracy of stroke alerts at University of Colorado Hospital. Methods: Retrospective chart review was performed on 1,962 inpatient and Emergency Department stroke alerts at University of Colorado Hospital from July 2022 through the end of June 2023. Primary stroke alert symptoms were divided into categories: language deficit, speech deficit, unilateral weakness, unilateral sensory loss, crossed weakness, crossed sensory loss, headache, diplopia, vision loss, vertigo, and encephalopathy. Based on documentation by the vascular neurology service, each case was assigned to a final diagnosis category: ischemic stroke, TIA, intracranial hemorrhage, recrudescence, toxic-metabolic, seizure, functional, or other (including brain tumor, peripheral vertigo, syncope, and many other diagnoses). Results: Out of 1,962 stroke alerts reviewed, 1,825 cases were analyzed for this study. Regarding primary symptom categories, 23.3% of patients presented with encephalopathy, 24.7% with unilateral weakness, 12.2% with unilateral sensory loss, 12.3% with vertigo, 8.8% with language deficit, 8.5% with speech deficit, 3.4% with headache, 3.0% with vision loss, 1.9% with crossed weakness, 1.1% with crossed sensory loss, and 0.8% with diplopia. Regarding final diagnosis categories, 22% of patients received a diagnosis of ischemic stroke, 3% TIA, 4% intracranial hemorrhage, 8% seizure, 29% toxic-metabolic, 4% recrudescence, 13% headache, 6% functional, and 11% other. Conclusions: Twenty-five percent of stroke alerts at University of Colorado hospital between June 2022 and the end of July 2023 resulted in a final diagnosis of an ischemic event (22% ischemic stroke and 3% TIA). Intracranial hemorrhage accounted for another 4% of stroke alerts. Therefore, over 70% of cases were not due to cerebrovascular causes with the most common non-cerebrovascular diagnoses including toxic-metabolic (29%), headache (13%), other (11%), and seizure (8%). Findings overall support re-evaluation of stroke alert criteria at University of Colorado Hospital. These findings can be used to improve stroke alert criteria as well as guide adjustments to staff education and training regarding stroke symptoms and stroke alert criteria.