LAUSR

Abstract Introduction: Organizing acute stroke care effectively reduces disability and mortality. Since the Ministry of Health in Brazil established the National Stroke Policy in 2012, stroke care has improved significantly. However, despite the increase in stroke centers, some hospitals have not fully implemented the recommended structure and protocols. This study aims to evaluate the quality of stroke services in Brazil based on the World Stroke Organization (WSO) Roadmap, marking the first step toward the Certification of Stroke Centers in Latin America. Method: From 2020 to 2022, we assessed the structure of stroke centers in Brazil via an online survey based on the WSO Roadmap. When multiple responses came from the same hospital, we checked for consistency and contacted the stroke center coordinator if needed. We then compared these findings to the structure of stroke centers available in 2008, before the national stroke plan began. Results: The number of stroke centers in Brazil increased from 35 in 2008 to 246 in 2022, with 216 centers assessed in this study (102 Essential, 114 Advanced). Advanced centers were mostly private (69%). Of all hospitals, 51% serve public health patients, 75% as Essential centers. The southeast and south region have the highest number of stroke centers (77%). All hospitals provided essential blood tests, CT scans, and thrombolytic therapy, with 97% having pre-hospital emergency services. Neurologists were available 24/7 in 85% of centers (49% on call, 35% on duty, 16% via telemedicine), and 46% of hospitals had stroke units. Nearly 90% had acute neurosurgical care, and 47% offered endovascular thrombectomy 24/7. Advanced centers implemented 85% of the WSO Roadmap items and Essential centers 76%. According to WSO/SIECV Certification, 39 centers were prepared for certification, and 18 were certified (6 private: Advanced, 12 public: 4 Advanced, 8 Essential). Conclusion: Brazil has significantly improved its stroke care structure, but disparities and areas for further enhancement remain, particularly in equity, resource access, and best practices implementation. Certification programs could help address these issues and improve outcomes for stroke patients. Plain Language Summary A stroke is a medical emergency that happens when the blood supply to a part of the brain is interrupted or when a blood vessel in the brain bursts. This can lead to brain damage, disability, or even death. Organizing care for stroke patients quickly and efficiently is essential to mitigate these risks. In Brazil, stroke care has experienced significant advancements since the Ministry of Health established the National Stroke Policy in 2012. This policy aimed to enhance stroke treatment by organizing stroke centers throughout the country. While many new stroke centers have been developed, not all hospitals have fully adopted the recommended structures and protocols to optimize care. From 2020 to 2022, this study assessed the quality of stroke services in Brazil based on standards established by the World Stroke Organization (WSO). Researchers surveyed 216 stroke centers, comparing their setups to what was available before the national stroke plan commenced in 2008. The results showed that the number of stroke centers in Brazil increased from 35 in 2008 to 246 in 2022, with most located in the southeast and south regions. Key services, including blood tests, CT scans, and therapies to dissolve stroke-causing clots, are widely available, and nearly all centers provide emergency services. However, disparities persist in resource availability and the implementation of best practices, especially in underfunded areas. Introducing certification programs for stroke centers could help bridge these gaps and further improve outcomes for stroke patients throughout Brazil.