Hemorrhagic stroke remains a major cause of prehospital morbidity and mortality, yet its early recognition is often challenging. Identifying prehospital clinical factors associated with intracerebral hemorrhage (ICH) may improve triage and expedite definitive care.

We conducted a nominal logistic regression analysis of 2,938 suspected stroke cases transported by Polk County Fire Rescue between 2020 and 2024. The dependent variable was ICH (yes vs. no). Candidate predictors included demographic variables, vital signs, BEFAST score components, and prehospital symptom reports. Odds ratios (OR) with 95% confidence intervals (CI) were generated.

The overall model was significant (χ²=133.0, df=18, p<0.0001), with MAP, witnessed loss of consciousness/altered mental status (LOC/AMS), headache characteristics, and sex emerging as significant predictors

Elevated mean arterial pressure (MAP) was the strongest factor, with each mmHg increase associated with a 2.3% higher odds of ICH (OR=1.023, 95% CI 1.017–1.028, p<0.0001). Witnessed LOC/AMS without trauma was independently associated with increased odds of hemorrhage (OR=3.38, 95% CI 1.33–8.58, p=0.01). Similarly, patients presenting with first, worst, or persistent headaches were more likely to have hemorrhage (OR=4.28, 95% CI 1.14–16.06, p=0.03). Female sex showed a borderline protective association (OR=0.76, 95% CI 0.58–1.00, p=0.047). Other BEFAST elements, including weakness, speech changes, facial droop, and balance abnormalities, were not significant independent predictors.

Among suspected stroke patients, elevated MAP, sudden LOC/AMS, and severe headache characteristics were the most salient prehospital indicators of hemorrhagic stroke. These findings reinforce the importance of routine blood pressure assessment and detailed history-taking in the field, as such factors may augment existing stroke triage tools. Incorporating high-risk features into prehospital screening could enhance differentiation between ischemic and hemorrhagic stroke, improving resource allocation and care pathways.