Introduction: Stroke alerts are designed to rapidly identify patients with acute stroke and expedite time-sensitive interventions such as thrombolysis or thrombectomy. In the emergency department, stroke alerts are frequently activated for patients who are not experiencing acute stroke or are ineligible for reperfusion therapy, consuming resources and potentially delaying care for themselves or others. Understanding which clinical features of stroke alerts predict intervention may improve efficiency and outcomes. This study aimed to determine the proportion of stroke alerts in a single emergency department that resulted in acute reperfusion therapy and to identify predictors of treatment. Methods: We retrospectively analyzed patients listed in the target hospital’s stroke code dataset who presented as an emergency department stroke alert from April 1, 2022, to February 5, 2023. Data included demographics, mode of arrival (EMS vs. non-EMS), timing of presentation, relevant medical history, and clinical symptoms. Multivariable logistic regression identified factors associated with reperfusion therapy. Results: Among 296 stroke alerts, 16.2% received reperfusion therapy. Significant predictors of intervention included mode of arrival, time from last known normal, and neurological findings. Non-EMS arrivals had 5.37-fold higher odds than EMS arrivals (B = 1.680, p = 0.040). Each additional minute from last known normal to arrival decreased odds of treatment by 0.3% (B = – 0.003, p = 0.002), corresponding to approximately 24% lower odds over 100 minutes. Facial paralysis increased odds 4.9-fold (B = 1.589, p = 0.027), language impairment 3.1-fold (B = 1.128, p = 0.041), and visual loss reduced odds by 79% (B = – 1.548, p = 0.027). Other factors, including age, sex, glucose level, motor deficits, and prior stroke, were not statistically significant predictors. Conclusion: In conclusion, fewer than one in five patients presenting as an emergency department stroke alert received reperfusion therapy. While stroke alerts remain essential for timely intervention, many are triggered for patients without stroke or who are ineligible for treatment. These findings highlight the need to refine activation criteria to improve specificity while maintaining rapid treatment for patients most likely to benefit.
Jovin et al. (Thu,) studied this question.