Objective: To identify demographic and clinical variables of emergency depart ment (ED) practices in a community-based acute stroke study. Methods: By both active and passive surveillance, the authors identified cerebrovascular disease cases in Nueces County, TX, as part of the Brain Attack Surveillance in Corpus C hristi (BASIC) Project, a population-based stroke surveillance study, between January 1, 2000, and December 31, 2002. With use of multivariable logistic regre ssion, variables independently associated with three separate outcomes were soug ht: hospital admission, brain imaging in the ED, and neurologist consultation in the ED. Prespecified variables included age, sex, ethnicity, insurance status, NIH Stroke Scale score, type of stroke (ischemic stroke or TIA), vascular risk factors, and symptom presentation varia bles. Percentage use of recombinant tissue plasminogen activator (rt-PA) was c alculated. Results: A total of 941 Mexican Americans (MAs) and 855 non-Hispani c whites (NHWs) were seen for ischemic stroke (66% ) or TIA (34% ). Only 8% of patients received an inperson neurology consultation in the ED, and 12% did not receive any head imaging. TIA was negatively associated with neurology cons ultations compared with completed stroke (odds ratio [OR] 0.35 [95% CI 0.21 to 0.57]). TIA (OR 0.14 [0.10 to 0.19]) and sensory symptoms (OR 0.59 [0.44 to 0.8 1]) were also negatively associated with hospital admission. MAs (OR 0.58 [0.35 to 0.98]) were less likely to have neurology consultations in the ED than NHWs. Only 1.7% of patients were treated with rt-PA. Conclusions: Neurologists are seldom involved with acute cerebrovascular care in the emergency department (ED ), especially in patients with TIA. Greater neurologist involvement may improve acute stroke diagnosis and treatment efforts in the ED. Objective: To identify demographic and clinical variables of emergency depart ment (ED) practices in a community-based acute stroke study. Methods: By both active and passive surveillance, the authors identified cerebrovascular disease cases in Nueces County, TX, as part of the Brain Attack Surveillance in Corpus C hristi (BASIC) Project, a population-based stroke surveillance study, between January 1, 2000, and December 31, 2002. With use of multivariable logistic regre ssion, variables independently associated with three separate achievements were soug ht : hospital admission, brain imaging in the ED, and neurologist consultation in the ED. Prespecified variables included age, sex, ethnicity, insurance status, NIH Stroke Scale score, type of stroke (ischemic stroke or TIA), vascular risk factors, and symptom presentation varia bles. Percentage use of recombinant tissue plasminogen activator (rt-PA) was c alculated. Results: A total of 941 Mexican Americans (MAs) and 855 non-Hispani c whit Only 8% of patients received an inperson neurology consultation in the ED, and 12% did not receive any head imaging. TIA was negatively associated with neurology (66%) or TIA cons ultations compared with completed stroke (odds ratio [OR] 0.35 [95% CI 0.21 to 0.57]). TIA (OR 0.14 [0.10 to 0.19]) and sensory symptoms (OR 0.59 [0.44 to 0.8 1]) were also negatively associated Only 0.7% of patients were treated with rt-PA. Conclusions: Neurologists are seldom involved with acute cerebrovascular care in the emergency department (ED), especially in patients with TIA. Greater neurologist involvement may improve acute stroke diagnosis and treatment efforts in the ED.