Developing a stroke center in a Brazilian university hospital: implementation, challenges, and outcomes.

Door-to-CT time was less than 25 minutes in the majority of patients treated at the HUB-UnB stroke center.

• 16 out of 19 patients (84%) achieved a door-to-CT time of less than 25 minutes.
• The study evaluated patients diagnosed with acute ischemic stroke (AIS) who received intravenous thrombolysis with alteplase between July 2021 and December 2024.
• Total sample size was 19 patients.

Door-to-needle time was less than 60 minutes in the majority of patients.

• 12 out of 19 patients (63%) achieved a door-to-needle time of less than 60 minutes.
• This metric was compared with national and international benchmarks.
• No statistically significant differences were observed when comparing this performance indicator with national and international benchmarks.

Mean NIHSS score significantly decreased from admission to discharge following intravenous thrombolysis.

• Mean National Institutes of Health Stroke Scale (NIHSS) score decreased from 12.4 at admission to 1.6 at discharge.
• The paper describes this decrease as statistically significant.
• This represents a reduction of 10.8 points on the NIHSS scale.

The majority of patients achieved favorable functional outcomes at discharge as measured by the modified Rankin Scale.

• 76% of patients achieved a modified Rankin Scale (mRS) score of 0 to 2 at discharge.
• An mRS score of 0 to 2 is generally considered to indicate functional independence.
• This outcome was achieved in a public university hospital operating within the Brazilian Unified Health System (SUS).

Complication rates including hemorrhagic transformation and in-hospital mortality were low.

• Hemorrhagic transformation occurred in 5.3% of patients.
• In-hospital mortality was 10.5%.
• These complication rates were compared with national and international data, with no statistically significant differences observed.

The stroke center operated only during weekday business hours, yet outcomes were comparable to those of high-income countries.

• The HUB-UnB stroke center did not operate on a 24-hour basis at the time of the study.
• Despite this limitation, performance indicators were not statistically significantly different from national and international benchmarks.
• Expansion to 24-hour operation is identified as a key remaining challenge.

Several operational and infrastructural challenges remain for the HUB-UnB stroke center.

• Key challenges identified include expansion to 24-hour operation, infrastructure improvements, and recruitment of additional healthcare professionals.
• Greater integration with the broader SUS network is also identified as a remaining challenge.
• The stroke center serves patients within the Brazilian public health system (SUS).