title: Code stroke: multicenter experience with in-hospital stroke alerts.
abstract: Between 2.2% and 17% of all strokes have symptom onset during hospitalization in a patient originally admitted for another diagnosis or procedure. A response system to rapidly evaluate inpatients with acute neurologic symptoms facilitates evaluation and treatment of stroke developing during hospitalization. The National Stroke Association implemented an in-hospital stroke quality-improvement initiative from July 2010 to June 2011 in 6 certified stroke centers from Michigan, South Carolina, Pennsylvania, Colorado, Washington, and North Carolina. Three hundred ninety-three in-hospital stroke alerts were examined over a 1-year period. Of the alerts, 42.5% were for ischemic stroke, 8.7% probable or possible TIA, 2.8% intracranial hemorrhage, and 46.1% were stroke mimics. The most common stroke mimics were seizure, hypotension, and delirium. Participating hospitals had an alarm rate for diagnoses other than acute cerebrovascular events ranging from 28.0% to 66.7%. Of 194 in-hospital stroke/transient ischemic attack cases, 8.2% received intravenous thrombolysis alone, 10.3% received intra-arterial/mechanical thrombolysis alone, and 1% received both. No patient with a stroke mimic received thrombolysis. Our findings suggest that in-hospital response teams need to be prepared to respond to a range of acute medical conditions other than ischemic stroke.
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; National Stroke Association, Centennial, Colorado.
authors.forename: Ethan
authors.initials: E
authors.lastname: Cumbler
authors.forename: Jennifer
authors.initials: J
authors.lastname: Simpson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D057209:Hospital Rapid Response Team / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement / Q000592:standards*; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D055815:Young Adult