Prognostic factors related to neurological disability after the implementation of the first stroke unit in a remote region of Brazil

01/09/2026

AI Summary

Implementation of the Stroke Unit in Roraima significantly reduced neurological sequelae severity and mortality compared with historical data.
Age over 70, prior stroke, and structural heart disease were independently associated with increased risk of moderate-to-severe disability at 90 days.
Thrombolysis, performed in 12.5% of patients, halved moderate-to-severe sequelae, but access remained limited due to delayed hospital admission.

Arq Neuropsiquiatr. 2026 Sep;84(9):1-10. doi: 10.1055/s-0046-1827210. Epub 2026 Aug 31.

ABSTRACT

BACKGROUND: Stroke is the main public health problem in Brazil.

OBJECTIVE: To evaluate the incidence of moderate-to-severe disability in patients admitted to the Stroke Unit in Roraima (2024), and estimate the impact of Stroke Unit implementation on neurological outcomes compared with historical data.

METHODS: This hospital-based observational cohort study assessed factors associated with moderate-to-severe disability in patients admitted to the Stroke Unit. Clinical and sociodemographic data were collected using a semistructured questionnaire. Participants were evaluated daily until discharge or death using the National Institutes of Health stroke scale (NIHSS).

RESULTS: A total of 400 patients was included. Mean age was 64.2 ± 15.8 years, and 52% of patients were male. Most cases were of ischemic stroke (82.2%), followed by wake-up stroke (13%), transient ischemic attack (TIA: 10%), and hemorrhagic stroke (1%). Systemic arterial hypertension (SAH: 57.1%), and diabetes (33.1%) were the most frequent comorbidities. Nearly 80% of patients were discharged, and the mortality rate was 3.7%. According to the modified Rankin Scale (mRS), moderate-to-severe disability at day 90 was associated with age > 70 years (RR = 1.45; 95% CI = 1.02-4.53), previous stroke (RR = 1.35; 95% CI = 1.12-3.42), and structural heart disease (RR = 1.80; 95% CI = 1.23-3.28). Thrombolytic therapy was performed in 12.5% of cases and reduced moderate-to-severe sequelae by 50%.

CONCLUSION: Stroke Unit implementation represented a significant advance in stroke care in Roraima, reducing sequelae severity and mortality, including among older patients. However, access to thrombolytic therapy remains limited due to delayed hospital admission.

PMID:42674467 | DOI:10.1055/s-0046-1827210

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