• Mariana de Almeida Moraes, Pedro Antônio de Jesus, Ludimila Santos Muniz, Camila Antunes Baccin, Alexandra Bahia Mendonça Barreto, Rilary Silva Sales, Cláudia Geovana da Silva Pires, Carlos Antônio de Souza Teles, and Fernanda Carneiro Mussi.
• MSc, PhD. Nurse and Adjunct Professor, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
• Sao Paulo Med J. 2023 Jan 1; 141 (6): e2022510e2022510.

BackgroundStroke is a major cause of death and functional disability worldwide. Knowledge of the associated factors is essential for defining education, management, and healthcare strategies.ObjectiveTo analyze the association between arrival time at a neurology referral hospital (ATRH) and functional disability in patients with ischemic stroke 90 days after the event.Design And SettingProspective cohort study conducted at a public institution of higher education in Brazil.MethodsThis study included 241 people aged ≥ 18 years who presented ischemic stroke. The exclusion criteria were death, inability to communicate without companions who could answer the research questions, and > 10 days since ictus. Disability was assessed using the Rankin score (mR). Variables for which associations showed a P value ≤ 0.20 in bivariate analysis were tested as modifiers between ATRH and disability. Significant interaction terms were used for multivariate analysis. Multivariate logistic regression analysis was performed with all variables, arriving at the complete model and adjusted beta measures. The confounding variables were included in the robust logistic regression model, and Akaike's Information Criterion was adopted to choose the final model. The Poisson model assumes a statistical significance of 5% and risk correction.ResultsMost participants (56.0%) arrived at the hospital within 4.5 hours of symptom onset, and 51.7% presented with mRs of 3 to 5 after 90 days of ictus. In the multivariate model, ATRH ≥ 4.5 hours and females were associated with more significant disability.ConclusionsArrival at the referral hospital 4.5 hours after the onset of symptoms or wake-up stroke was an independent predictor of a high degree of functional disability.

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