Implementation of a stroke code system in mobile, Alabama - Diagnostic and therapeutic yield

Background and Purpose There is now therapy of proven benefit for acute ischemic stroke. Successful interventional therapy for stroke patients requires implementation of a system that facilitates rapid triage and diagnostic evaluation. Methods We initiated a 24-hour, 7-day-per-week stroke code system at the University of South Alabama Hospitals and prospectively collected data from the first 100 patients whose clinical presentations triggered this system. Results Seventy-eight patients (78%) had acute ischemic stroke. Of the remaining 22, 9 had evidence of intracerebral hemorrhage. The most common nonstroke diagnosis was seizure (n=5). Forty-eight of the 87 stroke patients (55%) presented within 6 hours of stroke onset (40/78=51% of the ischemic stroke patients), and 35 of the 87 (40%) presented within 3 hours of onset (28/78=36% of the ischemic stroke patients). Thirty-one (31% of the group overall; 40% of the ischemic stroke patients) were eligible for acute therapy. Twenty-five of these eligible patients were entered into a treatment study, 4 declined participation, and 2 were treated with open-label tissue plasminogen activator. Conclusions Implementation of a stroke code system may result in a high yield of patients with acute stroke and relatively few ''stroke mimickers.'' A significant proportion of all cases generated will be eligible for acute treatment under current experimental protocols or with tissue plasminogen activator, but the majority will not.