Abstract Background and aims Early identification and appropriate triage of stroke in the prehospital setting are essential for timely treatment. In Region Zealand, Denmark, ambulance personnel are instructed to consult a neurologist when stroke is suspected to enable direct admission to a specialised stroke unit. However, limited knowledge exists on patients correctly suspected of stroke by EMS dispatchers who are not transported directly to a stroke unit, including whether neurologist consultation occurs and reasons for non-referral. The primary aim was to assess the frequency of neurologist consultation and documented reasons for non-referral. The secondary aim was to describe symptom presentation in this patient group. Methods This retrospective observational study linked prehospital ambulance records, Computer-Aided Dispatch data, and the Danish Stroke Register. Ambulance medical records were reviewed to assess decision-making. Included patients were aged ≥18 years, suspected of stroke by the EMS dispatcher, not transported directly to a stroke unit, and later registered with a stroke diagnosis corresponding to the same clinical event between January 2021 and September 2024 in Region Zealand. Descriptive statistics were applied. Results Among 680 patients, 583 (86%) were consulted with a neurologist. These patients were older and more often presented with typical stroke symptoms. Reasons for rejection were documented in 34% and included being outside the thrombolysis time window, contraindications to thrombolysis, few or atypical symptoms, or lack of stroke suspicion. Conclusions Most patients were consulted with a neurologist, but a notable proportion were not despite existing instructions. Documented rejection reasons suggest a need to review prehospital triage guidance. Conflict of interest
Drejøe et al. (Fri,) studied this question.