Differences in acute ischemic stroke treatment: A cross-sectional study from international Registry of Stroke Care Quality (RES-Q)
Mikulik R. Neto G. Sedani R. Ameriso S.F. Mammadova N. Marchenko S. Martins S. Milanov I. Constanzo F. Muñoz M. Budincevic H. Šrámek M. Ramos C. Zakaria M.F. Kõrv J. Tsivgoulis G. Szapary L. Pandian J. Nulkhasanah A. Batayha W. Medukhanova S. Karbozova K. Miglane E. Vilionskis A. Kee H.F. Gongora-Rivera F. Cantu Brito C. Groppa S. Ciobanu N. Paudel R. Abanto C. Collantes M.E. San Jose M.C. Kobayashi A. Gomes A. Tiu C. Shamalov N. Mijajlovic M. Gdovinová Z. Kroon L. Sohn S.-I. Moniche F. Towanabut S. Moskovko S. AlOmar A. Huy Thang N. Middleton S. Barrientos-Guerra J.D.
February 2026SAGE Publications Inc.
International Journal of Stroke
2026#21Issue 2188 - 199 pp.
Background: Stroke globally impacts mortality and disability. Compliance with international standards and evidence-based practices for acute stroke management would improve patient outcomes. Objectives: We aimed to present a descriptive analysis of the quality of acute stroke care across different countries using the Registry of Stroke Care Quality (RES-Q). Method: In a cross-sectional study, data from key quality indicators such as Emergency Medical Services (EMS) deployment rates, hospital arrival to imaging time (door-to-imaging: DIT), hospital arrival to thrombolysis time (door-to-needle: DNT), and Stroke Unit Care/Intensive Care Unit (SU/ICU) admission frequencies were examined. The analysis employed descriptive statistics and Spearman correlation tests. Results: Of 334,184 patients from 1130 hospitals in 70 countries, 218,832 patients (65.5%) from 47 countries were diagnosed with acute ischemic stroke after exclusions. The number of patients per country ranged from 226 to 62,080. International variability in care quality was observed: EMS (7–97%); SU/ICU (12–100%); and median DIT (7–41 min); and DNT (20–75 min). IVT rates varied markedly across countries, ranging from <1% to 52%. Higher patient volumes were positively correlated with SU/ICU admission and negatively with DIT and DNT (ρ = 0.10, –0.22, –0.42, respectively). Conclusion: This study demonstrates substantial international variation in the use of quality monitoring in clinical practice as well as in key indicators of acute ischemic stroke care, including intravenous thrombolysis rates and treatment timelines. The extent of variability highlights opportunities for benchmarking and targeted quality improvement efforts across diverse healthcare systems.
benchmarking , global health , registries , Stroke
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International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
Department of Neurology, Krajská nemocnice T. Bati, Zlín, Czech Republic
Health Management Institute, z.u., Brno, Czech Republic
Fundación Para la Lucha Contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
Republican Clinical Hospital, Baku, Azerbaijan
Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus
Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
University Neurological and Psychiatric Hospital “St. Naum, ” Sofia, Bulgaria
Hospital las Higueras de Talcahuano, Universidad Católica de la Santísima Concepción, Concepción, Chile
Marly Clinic, Bogota, Colombia
Sveti Duh University Hospital, Zagreb, Croatia
Military University Hospital, Prague, Czech Republic
Hospital Cabral y Baez, Union Medica del Norte, Santiago De Los Caballeros, Dominica
Ain Shams University, Cairo, Egypt
Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
“Attikon” University Hospital, Rimini Grecia. Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
Stroke Unit, University of Pécs Medical School, Pécs, Hungary
Christian Medical College, Vellore, India
National Brain Center Hospital, East Jakarta, Indonesia
Princess, Basmah Teaching Hospital, Irbid, Jordan
National Coordination Center for Emergence Medicine, Nur-Sultan, Kazakhstan
Neurology and Clinical Genetics Department, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
Pauls Stradins Clinical University Hospital, Riga Stradins University, Riga, Latvia
Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
Universiti Putra Malaysia, Selangor, Malaysia
Universidad Autónoma de Nuevo León, Neurology Department and Stroke Unit, University Hospital José Eleuterio González, Monterrey, Mexico
Center for Research and Development in Health Sciences (CIDICS). Tec Salud, Zambrano Hellion Medical Center, Neurology and Neurosurgery Institute, Garza García, San Pedro, Mexico
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de Mexico, Mexico
Institute of Emergency Medicine, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Chisinau, Moldova
Grande International Hospital, Kathmandu, Nepal
Instituto Nacional de Ciencias Neurológicas, Lima, Peru
Philippine General Hospital, Manila, Philippines
Institute for Neurosciences, St. Luke’s Medical Center Quezon City, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
Cardinal Stefan Wyszynski University, Warszawa, Poland
Centro Hospitalar Tondela, Viseu Viseu, Portugal
University Hospital Bucharest, Bucharest, Romania
Head of the Neurology Department, Moscow, Russian Federation
Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Faculty of Medicine, University Hospital L. Pasteur and P.J. Safarik University, Kosice, Slovakia
Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
Keimyung University Dongsan Hospital, Daegu, South Korea
Hospital Universitario Virgen del Rocio, Sevilla, Spain
Neurological Institute of Thailand, Bangkok, Thailand
National Pirogov Memorial Medical, Vinnytsia, Ukraine
Ibrahim bin Hamad Obaidullah Hospital, Ras Al-Khaimah, United Arab Emirates
People’s Hospital, 115, Ho Chi, Minh City, Viet Nam
Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Australian Catholic University, Sydney, NSW, Australia
School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
Departamento de Neurología, Hospital General San Juan de Dios, Ciudad de Guatemala, Guatemala
International Clinical Research Center
Department of Neurology
Health Management Institute
Fundación Para la Lucha Contra las Enfermedades Neurológicas de la Infancia (FLENI)
Republican Clinical Hospital
Minsk Scientific and Practical Center for Surgery
Neurology Department
University Neurological and Psychiatric Hospital “St. Naum
Hospital las Higueras de Talcahuano
Marly Clinic
Sveti Duh University Hospital
Military University Hospital
Hospital Cabral y Baez
Ain Shams University
Department of Neurology and Neurosurgery
“Attikon” University Hospital
Stroke Unit
Christian Medical College
National Brain Center Hospital
Princess
National Coordination Center for Emergence Medicine
Neurology and Clinical Genetics Department
Pauls Stradins Clinical University Hospital
Clinic of Neurology and Neurosurgery
Universiti Putra Malaysia
Universidad Autónoma de Nuevo León
Center for Research and Development in Health Sciences (CIDICS). Tec Salud
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Institute of Emergency Medicine
Grande International Hospital
Instituto Nacional de Ciencias Neurológicas
Philippine General Hospital
Institute for Neurosciences
Cardinal Stefan Wyszynski University
Centro Hospitalar Tondela
University Hospital Bucharest
Head of the Neurology Department
Neurology Clinic
Faculty of Medicine
Steve Biko Academic Hospital
Keimyung University Dongsan Hospital
Hospital Universitario Virgen del Rocio
Neurological Institute of Thailand
National Pirogov Memorial Medical
Ibrahim bin Hamad Obaidullah Hospital
People’s Hospital
Nursing Research Institute
School of Nursing
Departamento de Neurología
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