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Introduction: Inpatient strokes have a higher mortality risk and longer length of stay compared to community-onset strokes. The inpatient stroke population is often not included in national registries. This study examines a hospital-wide standardized process for acute triage of Code Stroke Inpatient Activations (CSIAs) at a Comprehensive Stroke Center.

Methods: CSIA data collected between September 2016-July 2018 from the Stroke and Rapid Response Team pager were used. False CSIAs were excluded. Outcomes included percentage of CSIAs by patient location (PL), primary problem (PP), and final discharge diagnosis (FDD), as well as percentage treated with IV-alteplase (tPA) and thrombectomy. Evaluation times of symptom discovery-to-stroke MD page (Sx-SMDP), symptom discovery-to-CT (Sx-CT), stroke MD page time-to-CT (SMDP-CT) were compared across PP and PL using one-way analysis of variance for log-transformed time with pairwise comparisons. Among CSIAs with a new stroke diagnosis at discharge, the percentage found in our Comprehensive Stroke Registry (CSR) was identified.

Results: Among all CSIAs (n=99), 47.1% (n=41) of patients were admitted for cardiac, post cardiac surgery or TAVR; 19.5% (n=17) for stroke; and 33.3% (n=29) for other PP. Among 79 CSIAs with PL, 30.4% (n=24) were in cardiac units, 24.1% (n=19) in stroke units, 21.5% (n=17) in non-stroke/non-cardiac units, 17.7% (n=14) in peri-procedural units and 6.3% (n=5) in the observation unit. Among 72 CSIAs with FDD, 72.2% (n=52) had a new stroke diagnosis whereas 27.8% (n=20) did not. Overall treatment rate was 6.0% with median Sx-tPA of 68 minutes (n=2) and median Sx-GP of 147 minutes (n=4). No differences in Sx-SMDP, Sx-CT, or SMDP-CT by PL or PP were found. Among 52 CSIAs with stroke FDD, 21.2% (n=11) were identified as inpatient strokes at discharge in our CSR.

Conclusions: Standardized Code Stroke Inpatient Activation process resulted in consistent evaluation times regardless of primary problem or patient location. Code Stroke Inpatient Activations in the cardiac population need further examination and may reflect the presence of comprehensive cardiac surgical services at this hospital. National stroke registries do not reflect the size or full spectrum of the inpatient stroke population.

Clinical Institute

Neurosciences (Brain & Spine)



Conference / Event Name

International Stroke Conference


Honolulu, HI, United States

Standardized Code Stroke Inpatient Activation Process Resulted in Consistent Acute Stroke Evaluation Times Regardless of Primary Problem or Patient Location

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Neurology Commons