Post-reperfusion Care in Stroke: Documentation Gaps and Opportunities for Quality Improvement
Stephanie Castro Turbi1, María Cedeño-Bruzual2, Diego Gil Troncoso2, Chanel Reyes2, Sabrina Lora2, Ruben Dario Bleubar Ozoria4, Francisco Méndez3, Edwina Luna Rodríguez1
1Neurology Department, 2Knowledge Management and Epidemiology Department, 3Emergency Department, Centers for Diagnostic, Advanced Medicine and Telemedicine (CEDIMAT), 4Instituto Tecnológico de Santo Domingo (INTEC)
Objective:
To assess clinical documentation gaps in post-reperfused acute ischemic stroke (AIS) patients that may limit outcome monitoring and quality improvement in stroke care pathways.
Background:
Post-reperfusion traceability in stroke units is critical to ensure continuity of care and reliable evaluation of treatment outcomes. Consistent documentation of NIHSS and mRS at key time points allows for standardized outcome assessment and data integrity. Incomplete records, however, hinder the capacity to measure treatment effectiveness and identify gaps in post-reperfusion management.
Design/Methods:
Retrospective observational study of AIS patients treated with IV thrombolysis (IVT) and/or mechanical thrombectomy (MT) at a Dominican tertiary care center (Aug 2022–Jun 2025) using data from the RES-Q registry. Documentation completeness was evaluated for NIHSS (baseline, discharge) and mRS (pre-stroke, discharge, 90 days). Descriptive statistics were performed in STATA 19.0.
Results:
Of 531 AIS patients, 17.1% (n=91) underwent reperfusion therapy, 57.1% (n=52) were male, with a median age of 73 years (IQR 19). Clinical traceability showed that 19.8% (n=18) had complete records, with 55.9% (n=50) having data entry errors, more frequently in door-to-imaging time. Baseline NIHSS and pre-stroke mRS was documented in 100% of cases. Discharge NIHSS and mRS were available in 82.4% (n=75) and 93.4% (n=85), respectively, while 90-day mRS follow-up was completed in only 14.2% (n=13). Documentation completeness was higher among patients admitted through the neurology service (95.9%, n=70). and those treated with IVT (60.3%, n=44) compared to MT (28.7%, n=21) or both (11.0%, n=8).
Conclusions:
Post-reperfusion documentation was largely complete for baseline and discharge metrics but failed to close the follow-up loop at 90 days. Strengthening standardized data collection and follow-up pathways is essential to improve continuity of care and outcome monitoring in acute stroke management.
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