Introduction: Stroke code activation is a crucial, time-sensitive protocol designed to speed up diagnosis and treatment in suspected cerebrovascular events. However, many of these activations may happen in patients who are ultimately not diagnosed with a stroke. We excluded traumatic brain injury and prio-stroek disgnosis. The effects of such activations—especially in ICU patients—on outcomes and healthcare resources are not well understood. This study examines the clinical and economic outcomes linked to stroke code activation in ICU patients without a confirmed stroke diagnosis, using a nationally representative database. Methods: We performed a retrospective cohort study using the 2022 NRD. Adult ICU patients were identified via ICD-10 codes. Stroke code activation without confirmed stroke was defined as stroke-alert procedures without a diagnosis of ischemic or hemorrhagic stroke on brain imaging. IPTW adjusted for baseline differences. Survey-weighted regressions evaluated associations with mortality, non-home discharge, ICU complications, 30-day readmission, LOS, and hospital charges. Results: Among 16. 5 million patients in the 2022 NRD cohort, 1. 5 million had inpatient stroke code activation without a confirmed stroke diagnosis, including 37, 440 ICU patients. The mean age in this ICU subgroup was 63. 7 years, and 44. 3% were female. Compared to other ICU patients, those with stroke code activation had significantly worse outcomes. After IPTW and survey adjustment, stroke code activation was associated with higher odds of in-hospital mortality (aOR 10. 16, p< 0. 001), non-home discharge (aOR 4. 76, p< 0. 001), new-onset seizures (aOR 2. 32, p< 0. 001), venous thromboembolism (aOR 4. 45, p< 0. 001), and pneumonia (aOR 11. 45, p< 0. 001). It was also linked to longer hospital stays (β = 7. 06 days, p< 0. 001) and higher hospital charges (β = 124, 221, p< 0. 001). Interestingly, 30-day readmission was slightly lower (aOR 0. 82, p=0. 017), possibly reflecting more discharges to skilled care. Conclusions: Our study showed that stroke code activation in ICU patients without confirmed stroke was associated with worse outcomes and higher resource use. These findings highlight the impact of over-triage in critical care. Prospective studies are needed to identify drivers of unnecessary alerts and improve diagnostic precision
Khan et al. (Sun,) studied this question.