Annual Code Stroke imaging expenditures rose nearly three-fold over six years while the number of patients receiving reperfusion therapy remained stable, resulting in a more than four-fold increase in average imaging cost per treated patient.
Annual Code Stroke activations nearly tripled from 2020 to 2025 at a single primary stroke center.
CTA head and neck utilization increased approximately 800% over the study period.
Annual imaging expenditure increased nearly four-fold from 2020 to 2025.
The number of patients receiving intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT) remained stable despite the large increase in Code Stroke activations.
The average imaging cost per treated Code Stroke patient increased more than four-fold over the study period.
The study was motivated by the hypothesis that increasing imaging expenditures would correspond to higher rates of reperfusion therapy following expanded IVT and EVT guideline indications.
This research suggests that hospitals are spending dramatically more money on brain imaging for suspected stroke patients, but this increased spending has not translated into more patients actually receiving stroke treatment. At one hospital over six years, the number of 'Code Stroke' emergency activations nearly tripled and the annual imaging bill grew from about $70,000 to nearly $260,000, largely because CT scans of the head and neck became used far more frequently. However, the number of patients who ended up receiving clot-dissolving drugs or procedures to remove blockages stayed roughly the same — about 16 to 19 patients per year. As a result, the cost of identifying each patient who actually needed and received treatment skyrocketed. In 2020, it cost on average about $3,700 in imaging to find and treat one stroke patient; by 2025, that figure had climbed to over $16,000. The treatment rate among all Code Stroke patients dropped from 14.3% to just 5.4%, meaning that by 2025, fewer than 1 in 18 patients triggered for emergency stroke evaluation actually received reperfusion therapy. These findings matter because they highlight a potential inefficiency in how emergency stroke protocols are being applied. While broader use of advanced imaging and stroke alerts can help catch more treatable strokes, this study suggests that the net of who gets a Code Stroke activated has widened considerably without a corresponding increase in patients benefiting from treatment. This raises questions about how stroke protocols should be designed and how resources can be allocated more efficiently in emergency stroke care.
Parikh N, Glick Y, Bryson A, Williams-Square D, Lu S. (2026). The rising cost of code stroke imaging and treatment: A six-year experience at a primary stroke center.. Clinical imaging. https://doi.org/10.1016/j.clinimag.2026.110936