AAN 2026 | Insights into the benefits and burdens of stroke codes
Vikas Rana, Icahn School of Medicine at Mount Sinai, New York City, NY, discusses the benefits and burdens of stroke codes, highlighting the disconnect between initiators and responders. Dr Rana notes that educational value is directly correlated with physician well-being, and that a tiered response system with an extra layer of screening before activating a stroke code may be beneficial. This interview took place at the 78th American Academy of Neurology (AAN) Annual Meeting in Chicago, IL.
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Transcript
Under the mentorship of Dr Laura Stein, we wanted to look at the benefits and burdens of stroke codes. We wanted to understand what was driving the high rate of stroke codes that were being called at our institution and to understand what the impact was on the residents who responded in terms of their educational status as well as their well-being. This is a relevant topic in the field of stroke neurology due to the fact that over the last couple of years, there’s been an increase in the number of cases...
Under the mentorship of Dr Laura Stein, we wanted to look at the benefits and burdens of stroke codes. We wanted to understand what was driving the high rate of stroke codes that were being called at our institution and to understand what the impact was on the residents who responded in terms of their educational status as well as their well-being. This is a relevant topic in the field of stroke neurology due to the fact that over the last couple of years, there’s been an increase in the number of cases. There’s been an increase in the number of stroke codes that have been called due to expanded guidelines regarding revascularization status. Over the course of four weeks last summer, we developed a survey and deployed it to stroke initiators and stroke responders after their role in a stroke code ended. We deployed this survey in both the emergency room as well as inpatient wards at Mount Sinai Hospital. As we were looking through the results, we noticed that there was a disconnect between the initiators and the responders. The initiators identified key points such as speed of calling the code as well as patient safety as the reasons for why they initiated the code. Yet, over 90% of the stroke codes during that time did not result in acute revascularization. This led to responders having various opinions, including some frustrations that focused around intake that was not providing the whole history, as well as patients presenting outside the therapeutic window for stroke treatment. Some positives, though, came from cases that did not result in stroke revascularization. Residents reported feeling joy and happiness when they were able to eliminate the fear of a stroke in patients. Another interesting finding was the fact that educational value was directly correlated with physician well-being. As well, the educational value that physicians took from participating in stroke codes that had revascularization was significantly greater than the educational value in cases where there was no treatment. Overall, we’re not proposing to decrease the number of stroke codes we call and we’re not proposing to only have residents participate in codes that have a hundred percent chance of revascularization. What we propose is some sort of tiered response system in which there is an extra layer of screening before a stroke code gets activated.
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