Abstract TP169: Subarachnoid Hemorrhage in a Low-Resource Setting: Epidemiology, Hospital Access, and Functional Outcomes

Introduction: Subarachnoid hemorrhage (SAH) carries high morbidity and mortality worldwide, yet regional data in low-and middle-income countries remain scarce, especially regarding referral pathways and access to specialized treatment, which have shown substantial advances in recent years for ischemic stroke but remain limited for SAH. Our objective was to describe the risk factors, access to care, and outcomes of patients with SAH in Fortaleza, Brazil, using a population-based stroke registry. Methods: We analyzed patients with SAH enrolled in a prospective stroke registry in Fortaleza, Brazil, from February to December 2014. The registry followed the WHO STEPS Stroke methodology. Demographics, vascular risk factors, acute management, and outcomes were analyzed using descriptive statistics. Logistic regression was applied to identify independent predictors of hospital care-seeking. Results: A total of 112 patients were included (mean age 57.0±13.1 years; 66% women). Hypertension was the most frequent risk factor (71%), followed by smoking (41%), alcohol use (32%), obesity (19%), and illicit drug use (8%). Most patients reached hospitals by private transport (40%), while 10% relied on emergency medical services. The median Glasgow Coma Scale (GCS) score on admission was 12 IQ95 [7,15]. A total of 71 patients (73%) arrived at the first medical service within 6 hours of symptom onset. However, only 29% were initially evaluated at the local comprehensive stroke center, while 71% received initial care in primary care units, which are not equipped to manage acute stroke. Patients evaluated at the comprehensive stroke center had a trend towards being older (mean age 60.0±13.5 years vs. 55.8±12.8 years, p=0.11) and presented with a lower GCS at admission (9 [6,14] vs 13 [8,15], p=0.03). Patients with at least 12 years of schooling were more likely to seek care at the comprehensive stroke center (p=0.02). No independent predictors of presenting to the comprehensive stroke center were identified. In-hospital mortality was 54%, and functional outcomes were poor, with only 24% of patients achieving independence at discharge. Conclusions: In this Brazilian cohort, SAH affected young patients with a high prevalence of modifiable risk factors, limited access to emergency transport, and high mortality. These findings highlight urgent needs for public health interventions targeting early recognition and improved emergency response systems in low- and middle-income settings.