Backgorund and Objectives: Stroke is a frequent condition, which is associated with high mortality. In Brazil, it is the major cause of deaths. This study aimed (1) to assess the conduct of doctors who have the initial contact with stroke patients and to compare it with the recommendations found in literature best evidence, and (2) to determine whether hospitals proposed to deal with medical urgencies and emergencies have enough equipment to provide the initial care of patients with stroke.

Methods: Doctors that worked in emergency rooms or intensive care units of 77 hospitals of Sao Paulo city were asked to fill in a questionnaire about diagnosis and treatment of two typical cases of acute ischemic stroke. The questionnaire included also data on hospital structure and doctors personal details. Answers were compared with literature standard recommendations for the management of acute ischemic stroke.

Results: Two hundred and fifty-one doctors participated in the study. Medical conducts were consistent with the ones recommended by literature best evidence in 14.7% and 4% of all questionnaires, respectively for diagnosis and treatment. In respect of at least one of both cases, doctors had their conducts considered inadequate in 35.5% and 89.6% of all questionnaires, for diagnosis and treatment respectively. Only three doctors (1.2%) were concordant with the recommended diagnosis and treatment in both cases. Doctor features, such as specialization, time since graduation, kind of work and number of strokes dealt in one year, as well as hospital characteristics (teaching or non teaching, private or public, secondary or tertiary hospital) did not interfere with the stated results because there were no statistical significance. Seventy-two percent of hospitals had appropriate diagnostic services, and 93.6% of hospitals had minimal or optimal conditions to treating patients with stroke.

Conclusions: Diagnostic and treatment of acute ischemic stroke varies a lot between doctors that work at emergency rooms and intensive care units, and literature best evidence recommendations. In addition, the quality of medical care performed in our setting seems to be poor as regards high quality studies recommendations. The main cause of the poor quality of stroke patients medical care in our setting are probably the fact that doctors who provide the initial care of patients with stroke do not know about diagnosis and treatment literature best evidence, in spite of the majority of Sao Paulo hospitals present reasonable minimum conditions for the attendance of patients with stroke.