SAN ANTONIO—Early identification of patients at risk for hemorrhagic stroke may be possible during pre-hospital history and physical examination, according to research presented at the 2016 meeting of the American Academy of PAs (AAPA).

John Ramos, and colleagues, Department of Physician Assistant Studies at Wake Forest School of Medicine in North Carolina, conducted a chart review of 257 consecutive Code Strokes from the database at Wake Forest Baptist Medical Center between January and September 2014. Medical records were reviewed using a survey of 45 findings considered common in stroke patients.

Of the 192 patients enrolled, 21 were diagnosed with hemorrhagic stroke (mean age, 62.8 years); 171 had a final diagnosis other than stroke. Other final diagnoses included ischemic stroke (109 patients), transient ischemic attack (15), and non-stroke diagnoses (47).

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The researchers found four history and physical examination findings in Code Stroke evaluation that were associated with increased probability of a hemorrhagic stroke diagnosis:

  1. “Thunderclap” or “10/10” headache
  2. Pupil abnormality
  3. Fall in last 24 hours
  4. Hypertension at presentation

“These findings may aid providers in the pre-hospital setting to identify patients who are at a higher risk of hemorrhagic stroke,” Mr. Ramos concluded.


  1. Ramos J, Gogg B, Joy S, et al. Developing a pre-hospital stroke survey for early identification of hemorrhagic stroke. ePoster presented at: 2016 meeting of the American Academy of PAs (AAPA); May 14-18, 2016; San Antonio, TX.