ABSTRACT NUMBER: ESOC2026A1245 NURSE-DRIVEN CANCELLATION OF PRE-HOSPITAL STROKE CODES: HIGH ACCURACY WITH LOW RISK OF MISSED ACUTE TREATMENT

Abstract Background and aims Pre-hospital stroke code activations frequently include patients ultimately diagnosed with stroke mimics, leading to unnecessary mobilization of acute resources. A protocol-driven pilot program was implemented empowering trained nurses to cancel pre-hospital stroke codes upon emergency department arrival when clinical assessment suggested a non-stroke diagnosis or a presentation that would not warrant acute intervention. The objective was to evaluate the accuracy and safety of this nurse-led triage approach. Methods During the pilot period, protocol-trained nurses assessed patients for whom a pre-hospital stroke code had been activated. When criteria code cancellation were met, the code could be cancelled, and the patient was triaged through the standard emergency department pathway. All cancelled cases were reviewed for final diagnosis and treatment eligibility. Results Among 107 cancelled stroke codes, 99 cases (92.5%) were ultimately diagnosed as stroke mimics, most commonly infection (26.2%), generalized weakness (15.0%), and other non-stroke etiologies (22.4%). Eight patients (7.5%) were later confirmed to have stroke. Of these, seven would not have been candidates for acute reperfusion therapy due to exclusion criteria (out of window = 1; poor baseline function = 3; minor/non-disabling = 2; spontaneous resolution = 1). One patient experienced delayed but ultimately successful treatment. Thus, only 0.9% of all cancellations had treatment implications. Conclusions Nurse-led stroke code cancellation accurately identified stroke mimics while maintaining a very low rate of missed treatment opportunities. This approach appears safe and efficient when applied by trained nursing staff with ongoing oversight, supporting its potential role in optimizing emergency stroke triage. Conflict of interest Michael Teithcer: nothing to disclose