• Code Stroke Imaging (CSI): MRI Or CT As First Scan For Acute Stroke Evaluation And Management

The purpose of this study is to test feasibility of a comparative effectiveness framework for acute stroke imaging using prospective electronic health data. This is a prospective, cohort feasibility study of patients presenting to the Emergency Department with suspected acute ischemic stroke. The clinical stroke team will not be blinded to the imaging modality given the nature and purpose of the interventions/imaging. Knowledge of the imaging modality used and the knowledge gained from the resulting data will need to be considered for treatment decisions. Blinding will be maintained for data abstraction and analyses. Analysis will be on an "intent-to-scan" basis and all qualifying patients will be included in their assigned cohort.

All patients will receive standard-of-care therapy and management based on AHA/ASA clinical practice guidelines. For patients with emergent large vessel occlusions, this will include adjuvant endovascular therapy if criteria, as stipulated in the guideline, are met. Although this is referred to as a prospective study, no data collection will occur until after standard of care procedures.

Population: "Code-Stroke" (potentially-treatable) patients, defined as patients presenting with clinical syndrome suggestive of stroke within 24-hours of time last known well will be included.

Setting: four certified stroke centers (Ascension Seton Williamson, Ascension Seton Medical Center, Ascension Seton Hayes, and Dell Seton Medical Center)

Rationale: There is current equipoise in selection of first scan modality for code stroke. The time-dependent efficacy of treatment with thrombolytics increases diagnostic burden on the stroke team, particularly less experienced providers. In efforts to minimize door to needle time (DTN), stroke mimics may be inadvertently treated with thrombolytics, particularly when insensitive diagnostics are used. The investigators plan to examine feasibility of comparing CT-first versus MR-first strategies to guide the development of a future large multicenter comparison.