Background
Hyperacute inpatient stroke response typically follows emergency department models of care. However, key differences exist in complexity of presentation, assessment and management. We evaluated the incidence, diagnostic accuracy and associated factors for inpatient code stroke activation at St Vincent’s Hospital, Melbourne.
Methods
Medical records were reviewed for all inpatients with Code Stroke activation between July 2023 and June 2025. Demographics, inpatient unit, symptoms leading to Code Stroke activation, stroke aetiology, and reperfusion therapy data were extracted. Imaging was reviewed for diagnostic confirmation.
Results
Of 114 identified Code Stroke calls, mean age was 67.6+/- 13 years, 47% female. The predominant symptom was weakness, followed by facial droop, reduced GCS and aphasia. Median code to imaging time was 24 minutes (IQR 18-37), with 48/114 (42.1%) imaging confirmed stroke and 42/48 (87.5%) ischaemic aetiology. Thirteen patients (13/42, 31.0%) underwent mechanical thrombectomy and 2/42(4.8%) received thrombolysis. Reasons for thrombolysis ineligibility were recent surgery (47.5%), intracranial haemorrhage (17.5%) and anticoagulation use (15%). Stroke calls highest for Cardiothoracics (21%), Stroke (11%), General Medicine (10%) and Neurosurgery (10%) with high stroke detection for Cardiology (7/10, 70%), Stroke (9/13, 69%) and Cardiothoracics (11/24, 46%) but low accuracy for General Medicine (3/12, 25%). Primary aetiology was cardioembolic (57.1%) and large artery atherosclerosis (21.4%).
Conclusion
Almost half of inpatient Code Stroke was for confirmed stroke with traditional high-risk mechanisms accounting for over 75% of cases and significant heterogeneity between specialties. These findings highlight potential for targeted quality improvement and education to prevent inpatient stroke and enhance early stroke recognition.