Retrospective analysis of stroke code activation in the emergency department of a large tertiary care center in Saudi Arabia

Background Stroke, a major cerebrovascular disorder with a high mortality that can lead to permanent disability, is the third leading cause of death in Saudi Arabia. Quick recognition of stroke symptoms and initiation of time-sensitive treatment can significantly change the course of stroke, and stroke code activation in the emergency department (ED) can expedite patient management. This study aimed to analyze the stroke code activation protocol against the set hospital standards in the ED of a tertiary care center in Saudi Arabia. Methods The data of patients aged ≥ 14 years who were admitted to the ED between January 2021 and January 2022, for whom the stroke code was activated in the ED, were retrospectively analyzed, and the time intervals from ED triage to stroke code activation, neurologist review, computed tomography (CT) imaging/reporting, and thrombolysis were determined. Results The study included 409 patients with a mean age of 60.12 ± 18.1 years and a mean weight of 73.4 ± 17 kg. Additionally, 61% of the patients were male, 26% of the patients were transported to the ED by ambulance, 63% of the patients were diagnosed with stroke based on CT imaging, and 43% of the patients were managed by mechanical thrombectomy. Furthermore, 91.12% of the patients with stroke had neurologic symptoms whereas 8.89% of the patients with stroke had atypical presentations. The mean time from ED triage to stroke code activation was 44.7 ± 49.6 min, the mean time from code activation to neurologist review was 12.1 ± 28.1 min, and the mean time from code activation to CT imaging was 51.9 ± 38.2 min, respectively. Conclusions Implementing the stroke code protocol in the ED can accelerate the diagnosis and treatment of patients with stroke. Delays in various stages in managing patients with stroke can be resolved with training and robust teamwork. Utilizing ambulance services to transport patients with stroke to appropriate centers can play a key role in expediting care.