Abstract Number: Esoc2026ys288 Outcomes of Nursing Home Residents Presenting as Fast Positive to Major Stroke Centre

Abstract Background and aims Nursing home (NH) residents represent a frail population at high risk of stroke, yet they are underrepresented in acute stroke trials. The Face Arm Speech Time (FAST) tool is widely used to expedite stroke recognition and transfer to specialist centres, but its appropriateness and outcomes in NH residents remain unclear. This study aimed to evaluate (1) the appropriateness of FAST in redirecting NH residents to a regional stroke centre and (2) reperfusion rates and outcomes among NH residents with acute ischaemic stroke (AIS). Methods We conducted a retrospective, consecutive cohort study of FAST-positive NH residents presenting to a regional comprehensive stroke centre in Dublin, Ireland, between January 2020 and June 2025. Demographic, clinical, frailty, diagnostic, treatment and outcome data were extracted from institutional stroke databases, electronic health records and the national stroke registry. Outcomes included diagnosis, reperfusion therapy rates, length of stay and mortality. Results 109 FAST-positive NH residents were included with mean Clinical Frailty Scale 6.7. Stroke was confirmed in 41 patients (37.6%), including 32 AIS (29.4%). 80 patients (73.4%) arrived within 6 hours of symptom onset. Among AIS patients, 25% received reperfusion therapy (IV thrombolysis and/or mechanical thrombectomy). In-hospital mortality was 12.2% in AIS. Outcomes did not significantly differ between AIS patients who did and did not receive intervention. FAST-positive NH residents frequently have confirmed stroke and present early, supporting direct transfer to acute stroke centres. Reperfusion therapy was used despite high frailty. Further prospective studies are needed to clarify the benefit of acute stroke interventions in this population. Conflict of interest Christiaan Strydom: northing to disclose. Emma Murtagh: nothing to disclose. Rachel Walsh: nothing to disclose. Dan Ryan: nothing to disclose.