Abstract Number: Esoc2026lb127 Prehospital Stroke Triage in Denmark: A Retrospective Observational Study of Emergency Medical Services Handling Confirmed Stroke Cases Not Admitted Directly to a Stroke Unit

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