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Randomized Controlled Trial
. 2026 Feb;57(2):324-337.
doi: 10.1161/STROKEAHA.125.051540. Epub 2025 Nov 3.

Partnering With an Urban Hospital for Stroke Preparedness in the Emergency Department: SPEDI Randomized Controlled Trial

Mellanie V Springer  1   2 , Tiffany M Hodges  1 , Devin L Brown  1   2 , Robert Miller  1 , Cristi Lanning  3 , Lewis B Morgenstern  1   4   5 , Michael Tupper  5 , Marc A Zimmerman  6 , Lesli E Skolarus  7
Affiliations
Randomized Controlled Trial

Partnering With an Urban Hospital for Stroke Preparedness in the Emergency Department: SPEDI Randomized Controlled Trial

Mellanie V Springer et al. Stroke. 2026 Feb.

Abstract

Background: We tested the Stroke Preparedness in the Emergency Department Intervention, an emergency department-based intervention that teaches stroke symptoms and the importance of calling 911, in a racially diverse community.

Methods: This was a National Institutes of Health-funded, single-center, participant-blinded parallel-group trial of adult emergency department patients randomized 1:1 to a brief pamphlet and video stroke preparedness intervention versus a general cardiovascular health control condition (Life's Simple 7; from February 2022 to August 2023). The primary outcome was intent to call 911 in response to 4 video vignettes (Video STAT instrument) depicting an actor having an acute stroke (stroke action score, range 0-8) at 1 month (delayed posttest). Secondary outcomes were recognition of the 4 videos depicting an acute stroke (stroke recognition score; range, 0-4) and the stroke action score immediately after treatment. Linear mixed models evaluated the association between intervention groups and each outcome, with adjustment for baseline characteristics, in a prespecified per-protocol analysis.

Results: Of the 353 participants randomized, 330 participants were included (159 in the intervention group, 171 in the control group, 61% female, 49% Black adults). The intervention group had a higher intent to call 911 than the control group on the immediate posttest (adjusted mean stroke action score difference, 1.14 points higher [95% CI, 0.78-1.50]; P<0.001) and on the delayed posttest (1.12 points higher [95% CI, 0.64-1.59]; P<0.001). The intervention group had higher stroke recognition than the control group on the immediate posttest (adjusted mean stroke recognition score difference, 0.40 points higher [95% CI, 0.23-0.56]; P<0.001) and on the delayed posttest (0.51 points higher [95% CI, 0.30-0.72]; P<0.001). Treatment effects did not differ by sex or race (P>0.05).

Conclusions: Among an adult emergency department population, a brief intervention increased intent to call 911 for stroke and increased recognition of stroke symptoms.

Keywords: ischemic stroke; ischemic stroke drug therapy; stroke; stroke therapy.

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Conflict of interest statement

Dr Springer reports grants from the National Institute of Neurological Disorders and Stroke and travel support from Oregon Health and Science University. Dr Morgenstern reports grants from the National Institutes of Health. Dr Skolarus reports grants from the American Heart Association and grants from the National Institutes of Health. The other authors report no conflicts.

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