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Updated: Apr 30, 2026

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Identifying wakeup stroke routine treatments in the emergency departments
Mehari Gebreyohanns1, Sidarrth Prasad1, Kim D Barker1
1Department of Neurology, UT Southwestern Medical Center, Dallas, TX, United States.
Background:
The term wake-up stroke refers to an acute ischemic stroke with an unknown time of onset, typically discovered when a patient awakens with symptoms. Wake-up strokes account for up to 25% of all acute ischemic strokes. There is limited understanding of how hospitals vary in their evaluation and treatment of these cases, and institutional protocols, imaging strategies, and therapeutic decision-making for wake-up stroke remain inconsistently defined.
Methods:
In this prospective observational study, we surveyed hospitals in Texas and Louisiana to assess institutional approaches to wake-up stroke care including hospital characteristics, imaging protocols, treatment pathways, and decision-making criteria for acute ischemic stroke with unknown onset time.
Results:
Among 54 hospitals in Louisiana (29), and Texas (25), representing 48 unique zip codes, >80% followed a standardized institutional protocol when making decisions for wake-up strokes. Additionally, 75.5% of hospitals ordered MRIs for these cases in the acute setting.
Conclusion:
A coordinated, systems-level approach to wake-up stroke care that integrates a standardized protocol may be valuable in promoting workflow processes.
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