Accuracy of Prehospital Emergency Service in Activating Acute Stroke Code

Background and purpose: Acute ischemic stroke is one of the main causes of death and long-term disability worldwide. Prehospital emergency diagnosis and subsequent transfer of stroke patients to the nearest stroke center for starting an appropriate treatment are critical steps in stroke rescue chain. In Iran, emergency medical technicians implement the SAMA code, following the diagnosis of acute stroke using FAST protocol, to manage the patients. Materials and methods: This retrospective cross-sectional study was conducted on patients who were referred to the prehospital emergency department of Hazrat Rasool Akram Hospital with the announcement of the SAMA code in 2019. The aim of this study was to evaluate the positive predictive value of the prehospital emergency technicians in the announcement of the SAMA code. Results: Of the 95 patients referred with the SAMA code, 19 patients diagnosed with hemorrhagic stroke (based on brain CT-scan) were excluded from the study. In 17.1% of the remaining 76 patients, diagnoses other than acute ischemic stroke were proposed. Ultimately, diagnosis of acute ischemic stroke was confirmed in 63 patients, and 25% of them were eligible for intravenous thrombolytic therapy, however, merely 5.26% of the eligible patients received the treatment. The positive predictive value of prehospital emergency service in referring patients diagnosed with acute ischemic stroke was determined to be 86.3%. Additionally, the positive predictive value for identifying acute cerebral stroke patients eligible for intravenous thrombolytic therapy was calculated to be 25%. Conclusion: This study revealed that prehospital emergency's positive predictive value for acute ischemic stroke identification was adequate. However, activating the SAMA code with greater diagnostic accuracy can save time and costs.