Criteria codes for unrecognized stroke/TIA patients by Emergency Medical Services dispatchers in Copenhagen, Denmark

BACKGROUND: Early diagnosis is essential in stroke treatment. Medical dispatchers play a key role in ensuring quick assessment, transport, and treatment of stroke patients by recognizing stroke symptoms. We investigated which diseases were suspected by the dispatchers as well as the dispatch priority in the emergency response, for unrecognized strokes/transient ischemic attacks (TIAs) in calls to Emergency Medical Services in the Capital Region of Denmark in the years 2015–2021.

METHODS: In this retrospective registry study, we collected data from the Danish Stroke Registry and from the electronic dispatch system used in Copenhagen Emergency Medical Services. We included all patients of 18 years of age or older, who called Copenhagen Emergency Medical Services and had an unrecognized stroke/TIA. We used chi-squared tests and multivariate logistic regression for statistical analysis.

RESULTS: For calls to Emergency Medical Call Centre (EMCC-112), the most frequent criteria code was suspicion of undetermined neurological illness (n = 1,621, 35.2%). For calls to Out-of-hours Services (1813-OOHS), the majority of calls (n = 3,971 50.9%) did not have a criteria code. The most frequent criteria code again was for “unspecific neurological illness” (n = 1,114, 14.3). Females more frequently received criteria codes for “unconscious adult” and “pain in extremities”, for calls to EMCC-112, while females more frequently we given the criteria code “heart and lungs” for calls to 1813-OOHS. Older patients were at risk of receiving a less urgent emergency response.

CONCLUSIONS: In many cases, the dispatchers did have a suspicion of neurological illness but failed to assign the correct, specific criteria code for stroke/TIA and/or the correct dispatch priority. Especially older patients were at risk of receiving a less urgent emergency response. Stroke recognition remains a challenge for medical dispatchers, but improvements in education and stroke specific tools may lead to improvements in dispatchers’ ability to recognize stroke.

CLINICAL TRIAL NUMBER: Not applicable.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12873-025-01335-4.