ABSTRACT NUMBER: ESOC2026A170 HEALTH ECONOMICS AND IMPLEMENTATION DETERMINANTS OF PREHOSPITAL TRIAGE INNOVATIONS FOR ACUTE SUSPECTED STROKE: A SYSTEMATIC REVIEW

Abstract Background and aims Effective prehospital stroke triage enables faster treatment and better patient outcomes. Although prehospital triage innovations are rapidly emerging, evidence regarding the balance between costs and benefits as well as implementation issues remain limited. This review aims to synthesise published evidence on health economics and implementation determinants of prehospital triage tools for acute suspected ischemic stroke patients. Methods A systematic search was conducted across five databases (CINAHL, Cochrane, EMBASE, PubMed, and Web of Science) between 1995-2025. Included were empirical studies of EMS-operated prehospital triage innovations for suspected stroke patients, with economic (e.g., ICER) or system-level implementation outcomes (CFIR constructs). Results were reported narratively, and reporting quality was assessed using CHEERS, STROBE-simulation, COREQ, and GRAMMS. Results From 6,491 screened studies, thirty-one were included: thirteen studies included health economic outcomes and eighteen reported implementation determinants. Prehospital triage tools assessed were: MSU (n=14), telemedicine (n=13), clinimetrics (n=1), prehospital MRI (n=1), biomarkers (n=1), and an AI-based microwave tool (n=1). Most studies (68%) were of high reporting quality. Positive results regarding cost-effectiveness were reported (n=11), including cost-savings (n=2), as well as for implementation determinants (n=11). However, evidence on sustained implementation was limited. More barriers (n=99) than facilitators (n=93) were reported, including workflow compatibility, work and IT infrastructure, role clarity, communication, design, and funding. Conclusions Included studies suggest most prehospital stroke triage tools are cost-effective, but implementation remains largely context dependent. Barriers including role delineation, compatibility, innovation design, complexity, and funding highlight the need for future studies to integrate health economics into an implementation science framework alongside clinical outcomes. Conflict of interest Nadja Alexandrov: nothing to disclose, Durk-Jouke van der Zee: nothing to disclose, Maud Eurlings: nothing to disclose, Maritta van Stigt: nothing to disclose, Monique Theunissen: nothing to disclose, Toine Janssen: nothing to disclose, Erik Buskens: nothing to disclose, Jonthan M. Coutinho: reports research support from Bayer and AstraZeneca (all fees paid to his employer) and is co-founder and shareholder of TrianecT, Maarten Uyttenboogaart: nothing to disclose, Maarten Lahr: nothing to disclose