Background/Aims: A code stroke is a coordinated, multi-disciplinary effort to expedite rapid treatment of acute stroke to optimise outcomes. We audited characteristics of patients identified by current code stroke systems at an Australian primary stroke centre, to guide local protocol and achieve national stroke care standards.
Methods: All code stroke alerts for patients presenting to the emergency department (ED) between 19 September and 2 December 2024 were identified prospectively, using the ED tracking platform. Clinical data was recorded from medical records.
Results: Of 211 code stroke alerts, 109 (52%) had a final diagnosis of stroke or transient ischaemic attack (TIA) (73 ischaemic stroke, 19 TIA, 17 haemorrhagic stroke). The stroke code originated from Ambulance pre-notification in 117 (55%), ED triage in 76 (36%), and during ED assessment, >30 minutes after triage in 18 (9%). Twenty-four (11%) received reperfusion therapy (19 (9%) thrombolysis only, 9 (4%) endovascular thrombectomy, and 4 (2%) thrombolysis and endovascular thrombectomy). An additional 7 (3%) received hyperacute antihypertensive management for intracerebral haemorrhage. Twenty-nine (14%) of code stroke calls were for patients with very low potential eligibility for acute therapies (>24 hours post symptom onset, premorbid dependency). The median door-to-CT, CT-to-needle and door-to-needle times were 29, 40 and 60 minutes, respectively.
Conclusion: Fifteen percent of code stroke alerts resulted in hyperacute management. Strategies for improving specificity whilst retaining sensitivity have been identified. This audit is being used to support local re-organisation of code stroke practices and devise a multi-component quality improvement intervention, to ultimately reduce treatment delays.