We have introduced a so-called “Neurosurgery Hotline” to detect stroke, severe head injuries and seizures without burdening duty doctors. All 556 registered cased during the last 3 years (January 2014 to December 2016) were compared to the registered 546 patients’ data between 2009 and 2012. The number of patients (557 vs. 546) and male/female ration was almost the same as the former data(289/261 vs. 285/261) but the mean age increased with statistical significance (69.0 years old vs. 65.0). 
The concordance rate of initial symptom with an exact stroke improved from 49.9% to 57.2% and number of properly referred patients also improved from 372 (68%) to 415 (74.6%). Speech disturbance (79.7%), paralysis (92.5%) and coma (93.3%) still showed high concordance rates.
On the contrary, representative stroke mimics such as, benign paroxysmal positional vertigo (26 to 15), hypertension (22 to 11), inflammatory diseases (22 to 15) and hypoglycemia (10 to 1) significantly decreased. 
Our hotline system has improved and still works well as a method for broad stroke triage. Finally, further work to eliminate and decrease stroke mimics is the key to improving this system.

Implementing a neurosurgery hotline system; a comparison of the last three years to the initially reported study