Association Between Pre-Hospital Stroke Code Activation Indicators and Short-Term Clinical Outcomes in Acute Stroke: a Cross sectional Study

Background: Stroke is a time-critical neurological emergency in which pre-hospital actions strongly influence eligibility for reperfusion therapies and functional recovery. Many health systems employ structured pre-hospital stroke notification pathways to accelerate triage and treatment. This study examined the association between pre-hospital stroke notification indicators and short-term clinical outcomes in patients admitted to a 24/7 stroke center. Methods: In this cross-sectional study, we analyzed 566 consecutive patients with confirmed stroke admitted to Namazi Hospital, Shiraz, during the second half of 2022. Hospital and pre-hospital emergency service (PHES) records provided data on mode of transport, application of FAST criteria, time from symptom onset to emergency department (ED) arrival, pre-hospital contact to ED admission, and time from ED admission to initiation of intravenous thrombolytic therapy. Outcomes were administration of intravenous thrombolysis, National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) scores at discharge, and in-hospital survival. Associations were assessed using standard parametric tests with a significance threshold of p < 0.05. Results: Of the 566 stroke patients, 331 (58.5%) were transported via PHES. Diagnostic concordance between PHES technicians using the FAST criteria and emergency physicians was 59%, while concordance with CT-scan findings was 76%. Patients who received thrombolytic therapy demonstrated significantly shorter prehospital contact-to-admission interval (p = 0.002). Conversely, prolonged pre-hospital contact times were significantly associated with poorer functional outcomes, indicated by higher mRS scores at discharge (p = 0.003). Notably, patients transported by PHES were significantly more likely to receive thrombolytic therapy (73.8%) but also exhibited higher mortality rates compared to those transported by companions or transferred from other facilities (p = 0.021 and p = 0.001, respectively). Conclusion: The findings demonstrate that timely identification and rapid transfer by pre-hospital emergency technicians are critical determinants of short-term clinical outcomes in stroke patients. Pre-hospital indicators within the stroke activation code framework, particularly transport times and mode of transfer, are significantly correlated with the administration of thrombolytic therapy and functional recovery as measured by the mRS. These results demonstrate the vital role of optimized pre-hospital services in stroke care pathways.