Abstract TP036: System-Wide Diagnostic and Therapeutic Yields of Emergency Department Code Stroke Activations

Background: Code Stroke protocols are recommended to facilitate efficient evaluation and management of patients with suspected acute ischemic stroke (AIS) and expedite stroke treatment, namely thrombolysis and/or thrombectomy in eligible patients. However, the diagnostic and therapeutic performance of these pathways is under-reported. We evaluated the rates of stroke diagnosis and treatment in patients evaluated via Emergency Department (ED) Code Stroke protocols across four large hub and spoke stroke networks within one large health system. Methods: Anonymized Code Stroke data from four stroke networks including a total of 51 EDs under a single healthcare system were prospectively collected into databases. Data from adult (≥18 years old) ED stroke activations occurring between January 2024-March 2025 were analyzed. The primary response variables were the proportions of patients with stroke as their primary discharge diagnosis, as identified via ICD codes, and proportions of activated patients receiving intravenous thrombolysis and/or mechanical thrombectomy. Secondary analyses evaluated differences in diagnosis and treatment between hospital stroke capabilities, stroke network, and patient demographics. Results: 24,974 consecutive Code Stroke activations were evaluated. As described in the accompanying table, 23.1% of patients evaluated for suspected stroke were diagnosed with AIS. 5.6% of activated patients were treated for AIS via thrombolysis (4.3-9.6% across networks), 2.2% underwent mechanical thrombectomy (1.6-3.3%), and 1.3% received both therapies (0.9-2.2%). Further secondary analyses, including differences in diagnosis and treatment rates between hospitals by stroke-treatment capability and patient demographics, will be reported as part of the abstract presentation. Conclusions: Acute ischemic strokes are diagnosed in a minority of ED Code Stroke activations and rates of stroke treatment with thrombolysis and/or thrombectomy among activated patients remain low. Further research is needed to optimize stroke identification and treatment in patients presenting to the ED and better understand variation across a large healthcare system.