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For suspected stroke, previous studies have focused on instances of neurological deterioration that occur after arrival at the emergency department (ED), in part because systematic data on initial prehospital assessments are required to identify any ultra-early deterioration that may have occurred in the field. A secondary analysis from the FAST-MAG study, a randomized trial of prehospital-initiated magnesium sulfate for hyper-acute stroke, provides the opportunity to better characterize this ultra-early period. Investigators compiled data on the initial prehospital evaluation of patients with suspected stroke and identified those who had deteriorated by ≥2 points on the Glasgow Coma Scale by the time they were reevaluated early during the …