Overlooked, Seldom Found

Jeff Clawson, MD

Brett Patterson

Greg Scott

Why does the Stroke Diagnostic launch for Not alert stroke patients? 

I know there is the “Patient unable to complete request” in each question of the diagnostic, but one can sound a bit silly when they have already told you they are Not alert and you start asking them to do things. 

I understand there is a high probability of stroke in the unable to complete option, but wouldn’t the high probability maybe relate to the Not alert answer? 

It is 0300 in the morning so I hope this made sense??


Mel Johnson

Hi Mel:

We did not disable the SDxT for patients recorded as Not alert because there is such a wide range of actual acuity in that subset of patients and many are able to complete the diagnostic. Additionally, we now get a positive result if the patient is unable (versus refused), and this can be clinically revealing. We would need some outcome data to estimate the relationship of unable to complete versus the Not alert condition as compared to Stroke Dx. However, because stroke can affect the patient’s level of consciousness, I would assume a relationship exists.

I have copied Greg Scott as he may be able to shed some light on the distribution of 28-C-1 patients with regard to SDxT suffixes.

Thoughts, Greg?

Brett A. Patterson

Academics & Standards Associate

Chair, Medical Council of Standards

International Academies of Emergency Dispatch

Brett & Mel,
To confirm what Brett is saying, we actually published a study on this topic (see below link). It turned out that the among “Not alert” patients, some could complete tasks in the Stroke Diagnostic Tool and some could not. Indeed, the patients who could not complete any of the tasks were at high risk for stroke. 


Greg Scott

Associate Director of Protocol Evolution

International Academies of Emergency Dispatch


There are obviously patients too sick to respond at all, and there are plenty of Not alert patients that can make an attempt. The point is that the unable to complete option is catching stroke patients, and this is a good thing.



I agree with the responses. I would add that doctors don’t “feel silly” when they ask things that often reveal pertinent negatives. Frenza’s Law is also pertinent here: “A thing not looked for is seldom found.” And, finally, “Don’t trip over seconds while looking for correctness.” 

Jeff Clawson, MD

Medical Director of the IAED Research, Standards, and Academics Division

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