Stroke Unit implementation in Roraima, Brazil represented a significant advance in stroke care, reducing sequelae severity and mortality, but access to thrombolytic therapy remains limited due to delayed hospital admission.
Key Findings
Results
The study cohort had a mean age of 64.2 years and was predominantly male, with ischemic stroke being the most common stroke type.
Total of 400 patients included in the hospital-based observational cohort study.
Mean age was 64.2 ± 15.8 years, and 52% of patients were male.
Most cases were ischemic stroke (82.2%), followed by wake-up stroke (13%), transient ischemic attack (10%), and hemorrhagic stroke (1%).
Systemic arterial hypertension (57.1%) and diabetes (33.1%) were the most frequent comorbidities.
Results
Nearly 80% of patients were discharged and the mortality rate was 3.7%.
Approximately 80% of patients were discharged alive.
Mortality rate was 3.7% among the 400 admitted patients.
Patients were evaluated daily until discharge or death using the National Institutes of Health Stroke Scale (NIHSS).
Results
Age greater than 70 years was significantly associated with moderate-to-severe disability at day 90.
Age > 70 years had a relative risk of 1.45 (95% CI = 1.02–4.53) for moderate-to-severe disability.
Disability was measured using the modified Rankin Scale (mRS) at day 90.
This association was identified through multivariate analysis of clinical and sociodemographic factors.
Results
Previous stroke was a significant prognostic factor for moderate-to-severe disability at day 90.
Previous stroke was associated with a relative risk of 1.35 (95% CI = 1.12–3.42) for moderate-to-severe disability.
Disability outcome was assessed using the modified Rankin Scale (mRS) at 90 days post-stroke.
This finding highlights prior cerebrovascular history as an independent predictor of worse outcomes.
Results
Structural heart disease was associated with the highest relative risk of moderate-to-severe disability at day 90.
Structural heart disease had a relative risk of 1.80 (95% CI = 1.23–3.28) for moderate-to-severe disability.
This was the strongest individual prognostic factor identified among clinical comorbidities.
Outcome was measured using the modified Rankin Scale (mRS) at 90 days.
Results
Thrombolytic therapy was administered in 12.5% of cases and was associated with a 50% reduction in moderate-to-severe sequelae.
Thrombolytic therapy was performed in 12.5% of the 400 patients.
Treatment reduced moderate-to-severe sequelae by 50%.
Access to thrombolytic therapy remains limited due to delayed hospital admission.
The low utilization rate reflects challenges in timely stroke recognition and transport in a remote region.
Discussion
The implementation of the first Stroke Unit in Roraima was associated with reduced sequelae severity and mortality compared with historical data.
This was the first Stroke Unit implemented in Roraima, a remote region of Brazil.
The study compared 2024 outcomes against historical data from the same region.
Improvements were noted including among older patients.
The study design was a hospital-based observational cohort using a semistructured questionnaire for data collection.
What This Means
This research examined outcomes for 400 stroke patients admitted to the first dedicated Stroke Unit in Roraima, a remote state in northern Brazil, during 2024. The study found that about 80% of patients were discharged alive, with a relatively low mortality rate of 3.7%. Three main factors were linked to worse outcomes at 90 days: being older than 70, having had a previous stroke, and having structural heart disease. The presence of a dedicated stroke unit appeared to improve care compared to historical data from the same region, including for elderly patients.
One important finding was that clot-busting treatment (thrombolysis) was only used in 12.5% of patients, even though it was associated with cutting the risk of serious disability in half. The main barrier was that patients were arriving at the hospital too late to safely receive this time-sensitive treatment. This highlights a significant challenge in remote and underserved regions, where delays in recognizing stroke symptoms and accessing hospital care can limit the benefits of advanced treatments.
This research suggests that establishing specialized stroke units even in remote or resource-limited settings can meaningfully improve patient outcomes, but that community education and faster emergency response systems are also needed to ensure more patients arrive in time to benefit from treatments like thrombolysis. The findings point to age, prior stroke history, and heart disease as key risk factors that clinicians should monitor closely when managing stroke patients in similar settings.
Fonseca A, Fonseca A, Martins L, Queiroz C, Oliveira Júnior J, Albuquerque A, et al.. (2026). Prognostic factors related to neurological disability after the implementation of the first stroke unit in a remote region of Brazil.. Arquivos de neuro-psiquiatria. https://doi.org/10.1055/s-0046-1827210