My question involves the stroke protocol, and utilizing the neurologist to confirm a code stroke.  I am often requested to bypass the closest hospital and transport to the stroke center.  Many pt's are exhibiting neurological symptoms, but not cva.  Why are we still transporting to the neuro center if it's not a code stroke?  The pt is able to get a ct and a neuro referral at the closest non neuro center. 

Thanks for the excellent question. Some strokes are obvious and sustained, and others present with some early symptoms then resolve, and then have an exacerbation, like a crescendo TIA. Paramedics encounter the patient at any of these stages. When the paramedic calls the stroke line then the stroke neurologist is looking for key findings, including time of onset, especially last seen well: moving everything, last time they spoke, to help stratify any risk vs benefit from treatment. There are many foils like partial seizures or the post-ictal period. This condition alone is common occurring in 1% of the population. Paramedic initial assessment is impeded by language barriers, previous strokes in the same patient, poor historians and short paramedic patient interaction times.  

Although many hospitals will have a CT scan as you note in the question, far fewer are set up to do a CT perfusion scan. This specialized imaging found in stroke centres includes a CT with contrast, which can see salvageable brain vs irreversibly damaged tissue in acute stroke patients. This information then helps guide immediate treatment. Sometimes even more advanced imaging such as MRI is required to help guide treatment.  

ER physicians are often contacted by the stroke neurologists prior to your arrival to do an immediate assessment to see if a code stroke should be activated for those borderline or non-specific cases. In some cases, even if the stroke was older, they would still benefit from, admission to the specialized stroke unit. In the case of TIAs that have resolved they would still get the ER imaging in many stroke centers to facilitate safe treatment and care in the TIA clinic.  

We hope this helps explain some of the reasons that you may still be asked to bypass to the stroke center.  

BLS,Stroke Bypass

Cerebrovascular Event, CVA, Stroke Bypass, TIA, Transient Ischemic Attack

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