Background and Purpose—Because acute ischemic strokes (ISs) are mainly hospitalized, hospital discharge data could be used to routinely follow their incidence management. We aimed to assess sensitivity and positive predictive value of the French hospital discharge database (HDD) to identify patients with acute IS using a prospective and exhaustive cohort (AVC69) of acute IS cases. Methods—A selection algorithm based on IS diagnosis coded with the International Classification of Diseases (ICD-10) and cerebral imaging codes was used to identify all hospital stays with the primary diagnosis of IS in the HDD of the university hospitals of the Rhone area. Cases identified through HDD search were compared with IS cases identified through an exhaustive cohort study conducted in the Rhone district and confirmed on medical records review. Results—There were 465 confirmed cases of IS hospitalized in 1 of the 4 university hospitals during the study period. The HDD search identified 313 among those (true-positive cas...