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

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.