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Comparison of Acute Stroke Outcomes Between Code Trauma vs Code Stroke Activations.

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Acute stroke patients presenting as trauma activations experience delayed brain imaging and worse outcomes. Streamlining imaging and early stroke recognition in these cases can improve care.

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Radiology

Background:

  • Acute stroke patients may be mistakenly activated as trauma cases, leading to diagnostic and treatment delays.
  • This atypical presentation can impact patient outcomes, necessitating a comparison between trauma and stroke activation protocols.

Purpose of the Study:

  • To compare time to brain imaging, reperfusion therapy use, and clinical outcomes between acute stroke patients presenting as trauma activations (CTA) and those presenting as code stroke activations (CSA).

Main Methods:

  • Retrospective review of trauma activations and code stroke activations at a Level I trauma center.
  • Comparison of door-to-imaging time, door-to-intervention time, discharge disposition, and mortality between CTA and CSA groups.

Main Results:

  • CTA patients were older, had higher rates of hemorrhagic stroke, and presented with greater stroke severity (NIHSS).
  • CTA patients experienced significantly longer door-to-imaging times (47.4 vs 24.8 minutes) despite minimal injuries.
  • CTA patients had lower rates of discharge home and higher mortality, although trauma activation itself was not an independent predictor of mortality.

Conclusions:

  • Acute stroke patients presenting as trauma activations face imaging delays and reduced thrombolytic treatment, impacting outcomes.
  • Delays in imaging and hemorrhagic stroke prevalence are key factors associated with mortality.
  • Workflow modifications, including streamlined imaging and early stroke recognition in low-impact trauma cases, are crucial for improving care delivery.