Large Language Models in the Acute Stroke Pathway: A Scoping Review of Applications, Evidence Maturity, and Implementation Readiness

Abstract

Background. Large language models (LLMs) have been rapidly adopted in medicine since late 2022, yet their role in the time-critical acute stroke pathway—from symptom recognition and prehospital triage to emergency diagnosis, imaging-related text tasks, reperfusion decision support, and acute-phase documentation and communication—has not been systematically mapped. Existing reviews cover the whole stroke-care continuum or mix LLMs with traditional NLP, leaving the acute phase under-characterized. Objective. To map the applications, evidence maturity, and implementation readiness of LLMs across the acute stroke pathway. Methods. This scoping review follows the PRISMA-ScR guideline. We search PubMed/MEDLINE, Europe PMC (including preprints), and Google Scholar for studies published from November 2022 onward. Eligible studies center on LLMs/generative AI applied to any stage of the acute stroke pathway. Two reviewers independently screen records and chart data using a piloted form. Evidence is synthesized along two dimensions: five pathway stages (prehospital recognition/dispatch; emergency triage and differential diagnosis; imaging-related text tasks; reperfusion decision support; acute documentation and communication) and three evidence-maturity tiers (simulation/benchmark; retrospective real-world data; prospective deployment). Implementation barriers (hallucination, bias, privacy, regulation, liability, integration, cost) are thematically summarized. Registration note. This review is registered on OSF; the full protocol is available in the attached files.