Identify mortality predictors among Hispanic patients with posterior circulation ischemic stroke (PCIS) outside the thrombolytic window based on their chief complaint.

PCIS, a unique subset of ischemic strokes, poses a higher risk of mortality than anterior circulation strokes due to its distinct vascular territory and varied clinical presentations. Despite the higher risks associated, there is a scarcity of research on mortality predictors in Hispanic populations. Identifying early clinical factors contributing to mortality in this population is crucial for guiding timely interventions and improving patient outcomes.

A retrospective study was conducted on Hispanic patients with PCIS, confirmed by computed tomography, who presented beyond the thrombolytic window at a stroke center in Ecuador in 2023. Data were obtained from medical records. A Logistic regression analysis was performed to assess the relationship between in-patient mortality and the following variables: age, sex, hypertension, diabetes, and chief complaint in the emergency department, including loss of consciousness, dysarthria, hemianopsia, facial palsy, motor deficits, dysphagia, dysmetria, seizures, and gait abnormalities. A 10,000-resample bootstrap analysis was used for validation. The primary outcome was in-hospital mortality.

We included 77 patients, the mean age of the cohort was 70±13 years, and 68.8% (53) were male. The overall mortality rate was 15.6% (12). Logistic regression analysis identified loss of consciousness as the most significant predictor of mortality (OR: 462.496; 95% CI: 6.415–33,341.820; p=0.005). All other variables did not reach statistical significance (all p>0.05). The model demonstrated an overall accuracy of 93.5%, with a Nagelkerke R² of 0.702.

Loss of consciousness upon presentation emerged as the strongest predictor of in-hospital mortality among Hispanic patients with PCIS outside the thrombolytic window. Given the limited impact of other clinical variables, timely recognition of loss of consciousness should be prioritized in the management of PCIS to enhance patient survival rates in this underserved population.