Stroke Code Transports by Emergency Medical Services: Positive Predictive Value and Therapeutic Decisions in a Large Finnish Province

Background and Aims Precise prehospital identification of cerebrovascular diseases (CVD) is essential for timely decisions concerning recanalization therapy for acute ischemic stroke (IS). This study described the stroke chain by analyzing patients transported by emergency medical services (EMS) with a stroke code, focusing on the EMS process regarding both CVD recognition and final recanalization decisions. Methods This retrospective, population‐based, observational study analyzed all consecutive patients transported by EMS with suspected acute CVD in the Helsinki University Hospital service area during a 4‐month period, irrespective of transport priority or receiving hospital. Prehospital and hospital patient records were combined, and the cohort was cross‐checked with the database of given recanalization therapies. Sex‐related and regional differences were assessed. Results Out of 1411 transports, 702 (50%) CVD diagnoses were identified. Of 521 high‐priority transports, 317 (61%) received a CVD diagnosis and 98 (19%) recanalization therapy. Any recanalization therapy was given to 97/415 (23%) IS patients and to 91/211 (43%) IS patients transported with high priority. There were no significant sex‐related or regional differences concerning diagnostic accuracy or treatment decisions. Altogether, 92% of the EMS transports ultimately leading to recanalization therapy were assigned high‐priority stroke code. Conclusions The Finnish EMS system seems relatively accurate in identifying cerebrovascular disease; of all stroke‐code transports, every second patient received a CVD diagnosis. Of the high‐priority transports, 19% led to recanalization decisions. We observed no signs of gender or regional inequity. Most patients who received recanalization therapy were correctly identified by the EMS and transported with high priority, but this inevitably came at the expense of specificity.