A single-site retrospective cohort on the profile of in-hospital stroke: an alarming sentinel of systemic failures.

Background: In-hospital stroke is associated with delayed recognition, reduced access to acute treatment, and worse outcomes, particularly in low- and middle-income countries. Objective: To characterize the clinical profile, care processes, and outcomes of patients with ischemic stroke occurring during hospitalization. Methods: The present retrospective cohort study included adult patients with ischemic stroke diagnosed during hospitalization at a comprehensive stroke center. Stroke recognition time was used as the reference point. Clinical characteristics, stroke severity, acute treatment, and in-hospital outcomes were analyzed. Primary outcomes were in-hospital mortality, discharge destination, and functional independence. Results: Fifty-two patients were included. Most strokes occurred in patients admitted for non-neurological conditions, mainly in surgical specialties. Stroke recognition was delayed in a relevant proportion of cases, and reperfusion therapy was infrequently performed, with no procedure-related complications. Moderate-to-severe strokes were common. In-hospital mortality was 9.6%, and functional status significantly declined from admission to discharge. Most patients received therapeutic care planning and were referred for rehabilitation. Conclusion: In-hospital ischemic stroke predominantly affects patients hospitalized for non-neurological conditions and is frequently recognized late, limiting access to reperfusion therapies. These findings highlight important gaps in in-hospital stroke detection and support the implementation of structured rapid-response protocols.