Research Targets for improving dispatcher identification of acute stroke Olli S Mattila 1,2 , Tuukka Puolakka 3 , Juhani Ritvonen 2 , Saana Pihlasviita 2 , Heini Harve 3 , Ari Alanen 4 , Gerli Sibolt 1 , Sami Curtze 1 , Daniel Strbian 1 , Mikko Pystynen 3 , Turgut Tatlisumak 1,5,6 , Markku Kuisma 3 and Perttu J Lindsberg 1,2 Abstract Background: Accurate identification of acute stroke by Emergency Medical Dispatchers (EMD) is essential for timely and purposeful deployment of Emergency Medical Services (EMS), and a prerequisite for operating mobile stroke units. However, precision of EMD stroke recognition is currently modest. Aims: We sought to identify targets for improving dispatcher stroke identification. Methods: Dispatch codes and EMS patient records were cross-linked to investigate factors associated with an incorrect dispatch code in a prospective observational cohort of 625 patients with a final diagnosis of acute stroke or transient ischemic attack (TIA), transported to our stroke center as candidates for recanalization therapies. Call recordings were analyzed in a subgroup that received an incorrect low-priority dispatch code indicating a fall or unknown acute illness (n ¼ 46). Results: Out of 625 acute stroke/TIA patients, 450 received a high-priority stroke dispatch code (sensitivity 72.0%; 95% CI, 68.5–75.5). Independent predictors of dispatcher missed acute stroke included a bystander caller (aOR, 3.72; 1.48–9.34), confusion (aOR, 2.62; 1.59–4.31), fall at onset (aOR, 1.86; 1.24–2.78), and older age (aOR [per year], 1.02; 1.01–1.04). Of the analyzed call recordings, 71.7% revealed targets for improvement, including failure to recognize a Face Arm Speech Time (FAST) test symptom (21/46 cases, 18 with speech disturbance), or failure to thoroughly evaluate symptoms (12/46 cases). Conclusions: Based on our findings, efforts to improve dispatcher stroke identification should primarily focus on improving recognition of acute speech disturbance, and implementing screening of FAST-symptoms in emergency phone calls revealing a fall or confusion. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02145663. Keywords Stroke, dispatcher identification, EMS, emergency call Received: 13 February 2018; accepted: 25 October 2018 Introduction The effectiveness of recanalization therapy in acute ischemic stroke is highly time-dependent, mandating healthcare systems to streamline acute stroke care. 1 Promptly calling the emergency number is the first cru- cial step in activating the stroke chain of recovery, aimed at rapid evaluation and transport of suspected stroke patients requiring in-hospital diagnostics and treatment. Emergency Medical Dispatchers (EMD) are faced with the daunting task of identifying stroke cases rapidly and with high sensitivity, although they represent only a small fraction of all emergency calls. 1 Neurology, Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland 2 Molecular Neurology, Research Programs Unit, University of Helsinki, Helsinki, Finland 3 Emergency Medicine and Services, Department of Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland 4 Emergency Response Center Administration, Kerava, Finland 5 Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg 6 Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden Corresponding author: Olli S. Mattila, Research Program of Molecular Neurology, University of Helsinki, Biomedicum Helsinki, Haartmaninkatu 8, Helsinki 00290, Finland. Email: olli.s.mattila@helsinki.fi International Journal of Stroke, 0(0) International Journal of Stroke 0(0) 1–8 ! 2019 World Stroke Organization Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1747493019830315 journals.sagepub.com/home/wso