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Introduction: Stroke patients recognized by dispatchers have an increased chance of receiving prehospital care with advanced life support and arrive at hospital earlier. There is limited research on factors associated with dispatcher recognition of stroke. This study aimed to: (1) understand the details of the dispatcher-caller communication among the calls for stroke patients, (2) identify factors associated with stroke recognition by dispatchers, and (3) evaluate the association between stroke recognition by dispatchers and stroke management.Methods: We conducted a multicenter retrospective study involving patients with stroke or transient ischemic stroke transported by the emergency medical service, and arriving at 9 hospitals in Taipei within 3 hours of symptom onset from January 1, 2013 to February 28, 2014. Patients were excluded if tape-recording data or prehospital management information were not available. Data of the enrolled patients were reviewed, including the tape recording of the dispatcher-caller communication, the type of dispatch determination, and patient characteristics. We used stroke dispatch determination as the surrogate for stroke recognition by dispatchers. Multivariable logistic regression was used to identify the factors associated with stroke dispatch determination.Results: A total of 507 patients were included. In approximately 50% of cases, callers were close family members. Ninety-one patients (17.9%) had stroke dispatch determination. After adjustment, stroke reported spontaneously, any one symptom included in the Cincinnati Prehospital Stroke Scale reported spontaneously, and dispatcher adherence to the protocol, were associated with stroke dispatch determination independently. Stroke dispatch determination was associated with receiving pre-arrival notification, shorter door-to-computed tomography time, and thrombolytic therapy.Conclusions: The sensitivity of recognizing stroke patients by dispatchers is suboptimal. Dispatchers should spend more time identifying stroke patients from those with frequently reported problems, by following the dispatch protocol. Recognition of stroke by dispatchers was associated with improved stroke care.