Protocols

Program for the epidemiological evaluation of stroke in Tandil, Argentina

(PREVISTA) study: rationale and design
Luciano A. Sposato1,2*, Mariano L. Coppola3,4,5, Juan Altamirano3,4,5,
Brenda Borrego Guerrero5, Jorge Casanova14, Maximiliano De Martino3, Alejandro Díaz3,
Valery L. Feigin6, Fernando Funaro4, María E. Gradillone3, María L. Lewin3,
Renato D. Lopes7,8,9, Daniel H. López4,5, Mariel Louge4, Patricia Maccarone4, Cecilia Martens3,
Marcelo Miguel4, Alejandro Rabinstein10, Hernán Morasso14, Patricia M. Riccio2,
Gustavo Saposnik11, Damián Silva3, Ramón Suasnabar4, Thomas Truelsen12, Araceli Uzcudun3,
Carlos A. Viviani13, and M. Cecilia Bahit1

The availability of population-based epidemiological data on
the incident risk of stroke is very scarce in Argentina and other
Latin American countries. In response to the priorities estab-
lished by the World Health Organization and the United
Nations, PREVISTA was envisaged as a population-based
program to determine the risk of first-ever and recurrent
stroke and transient ischemic attack incidence and mortality in
Tandil, Buenos Aires, Argentina.
The study will be conducted according to Standardized
Tools for Stroke Surveillance (STEPS Stroke) methodology and
Correspondence: Luciano A. Sposato*, Department of Clinical
Neurological Sciences, London Health Sciences Centre, Western
University, 339 Windermere Rd, Room C7-123. P.O. Box 5339, London,
ON, Canada N6A 5A5.
E-mail. lsposato@uwo.ca
Twitter: @SposatoL
1
Vascular Research Institute at INECO Foundation, Buenos Aires,
Argentina
2
Department of Clinical Neurological Sciences, London Health Sciences
Centre, Western University, London, ON, Canada
3
Hospital Ramón Santamarina, Tandil, Province of Buenos Aires,
Argentina
4
Nueva Clínica Chacabuco, Tandil, Province of Buenos Aires, Argentina
5
Sanatorio Tandil, Tandil, Province of Buenos Aires, Argentina
6
National Institute for Stroke and Applied Neurosciences, School of Reha-
bilitation and Occupation Studies, AUT University, Auckland, Northcote,
New Zealand
7
Paulista School of Medicine, Federal University of São Paulo, São Paulo,
SP, Brazil
8
Duke Clinical Research Institute, Durham, NC, USA
9
Brazilian Clinical Research Institute (BCRI), Sao Paulo, SP, Brazil
10
Neuroscience Intensive Care Unit, Mayo Clinic, Rochester, MN, USA
11
Stroke Outcomes Research Center, Li Ka Shing Knowledge Institute,
Departments of Medicine and Health Policy Management and Evaluation
(HPME) and Institute for Clinical Evaluative Sciences (ICES), St.
Michael’s Hospital, University of Toronto, Toronto, ON, Canada
12
Department of Neurology, Copenhagen University Hospital, Herlev,
Denmark
13
Círculo Médico de Tandil, Buenos Aires, Argentina
14
Neuroimaging Studies, Resonancia del Centro, Tandil, Argentina
Search Terms: Stroke, Transient Ischemic Attack, Epidemiology, Inci-
dence, Mortality, Population based.
Conflict of interest: Dr Gustavo Saposnik is supported by the Distinguished
Clinician Scientist Award from Heart and stroke Foundation of Canada.
None of the remaining authors have conflicts of interest to disclose.
Funding: None.
DOI: 10.1111/ijs.12171
will enroll all new (incident) and recurrent consecutive cases of
stroke and transient ischemic attack in the City of Tandil
between May 1st, 2013 and April 30, 2015. The study will
include patients with ischemic stroke, non-traumatic primary
intracerebral hemorrhage, subarachnoid hemorrhage, and
transient ischemic attack. To ensure the inclusion of every
cerebrovascular event during an observation period of two
years, we will instrument an ‘intensive screening program’,
consisting of a comprehensive daily tracking of every potential
event of stroke or transient ischemic attack using multiple
overlapping sources. Mortality would be determined during
follow-up for every enrolled patient. Also, fatal community
events would be screened daily through revision of death
certificates at funeral homes and local offices of vital statistics.
All causes of death will be adjudicated by an ad-hoc
committee.
The close population of Tandil is representative of a large
proportion of Latin-American countries with low- and middle-
income economies. The findings and conclusions of PREVISTA
may provide data that could support future health policy
decision-making in the region.
Key words: developing countries, epidemiology, hispanic, incidence,
mortality, stroke
Introduction and rationale
Rationale
Stroke is the second cause of death and a leading cause of acquired
adult disability worldwide (1,2). Although the incidence of cere-
brovascular disease has increased by over 100% between 1970 and
2008 in low- and middle-income countries, there has been a 42%
decrease in high-income nations (3). Low- and middle-income
countries have the largest burden of cerebrovascular disease, and
this burden will increase in the future unless effective preventive
interventions are implemented (4,5). The scarce availability of
high-quality epidemiological data on cerebrovascular disease in
many of these countries, particularly in Latin America, is a limi-
tation for health authorities’ awareness of the stroke burden and
for identification of priority areas for preventive interventions.
The United Nations (UN) has stated that it is crucial that Latin-
American countries improve their data collection systems for
assessing health indicators at the population level and for
measuring the impact of public health policies and resources
utilization (6). The availability of high-quality data on the
epidemiological burden of cerebrovascular disease in these

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International Journal of Stroke © 2013 World Stroke Organization
 Protocols L. A. Sposato et al.

countries is crucial for developing health policies aimed at dis- Methods

tributing resources more efficiently.
There are only a few well-designed, population-based, stroke
incidence studies in Latin America (7). Since year 2000, only four
population-based stroke incidence studies were conducted in
Latin America (8): Iquique (Chile, 2000–2002) (9), Matao (Brazil,
2003–2004) (10), Joinville (Brazil 2005–2006) (11), and Durango
(Mexico, 2007–2008) (12). Extrapolation of the findings of these
studies to other Latin-American countries is methodologically
problematic as they included different race-ethnic communities
and socio-demographically diverse populations, where data were
collected at least more than five-years ago. Also, socioeconomic
indicators, which are important determinants of stroke incidence
and mortality (9), were not completely assessed. In addition, no
stroke incidence studies have ever been conducted in Argentina.
The population of Tandil is representative of most of Latin-
American populations with low- and middle-income economies
(Table 1). Thus, the findings and conclusions of the program for
the epidemiological evaluation of stroke in Tandil, Argentina
(PREVISTA) could provide data that may guide future health
policy initiatives in the region.
Objectives
PREVISTA is an investigator-initiated population-based study
aimed at assessing the incidence and the incidence of first-ever
and recurrent stroke/transient ischemic attack (TIA), and death at
different points of time (28 days, six-months, and 12 months) in
the city of Tandil, Buenos Aires, Argentina.
PREVISTA was developed according to the criteria for studies of
stroke incidence, proposed by Sudlow and Warlow (20), and by
using the World Health Organization (WHO)’s Standardized
Tools for Stroke Surveillance manual (21,22).
Tandil City
The city of Tandil is located in the province of Buenos Aires,
360 km south from Buenos Aires City and more than 100 km
from the nearest stroke center. It is considered a referral city for
hospitalization and clinic consultations.
The Tandilean population is originated from few local inhab-
itants and a large immigration influx from Italy, Spain, France
(Basques), and Denmark.
The population is distributed along an urbanized area of
22·07 km2 (13·7 mi2) surrounded by a suburban area of 30·3 km2
(18·8 mi2). There are seven nearby cities at a mean distance of
103 ± 32 km (64 ± 20 mi). The nearest cities are Ayacucho and
Benito Juárez (both at 80 km/50 mi).
Owing to these unique features, it is unlikely for Tandilean
patients with acute stroke or TIA to seek medical attention else-
where. According to the 2010 National Census, the population of
Tandil was of 123 871 inhabitants. There is one public hospital
with 101 beds, two private hospitals with a total 134 beds, and 10
outpatient clinics. Four neurologists work in these outpatient
clinics, and approximately 350 physicians work in the city. There
are no stroke units in Tandil. In terms of availability of neuroim-

Table 1 Socioeconomic indicators of Tandil City and Latin-American countries (year 2010)

Population Population, Literacy rate, adult Mortality rate, GDP per capita Unemployment,
aged ≥65 (% female (% of total (% of people infant (per 1000 (current US$) male (% of male
City/country of total) (13) total) (14) ≥15 years) (15) live births) (16) (17) labor force) (18)

Tandil (19) 13 51·6 99 12 11·0 7·4

Argentina 11 51·1 98 13 9·1 7·8
Bolivia 5 50·1 91 41 2·0 NA
Brazil 7 50·8 90 15 11·0 6·1
Chile 9 50·6 99 8 12·6 7·2
Colombia 6 50·8 93 16 6·2 9·1
Ecuador 6 49·9 92 20 4·0 5·2
Paraguay 5 49·5 94 20 2·8 4·4
Peru 6 49·9 NA 15 5·3 4·4
Uruguay 14 51·7 98 9 11·7 NA
Venezuela 6 49·8 96 13 13·7 7·2

Population aged ≥65 (% of total): population ages 65 and above as a percentage of the total population. Population is based on the de facto definition
of population, which counts all residents regardless of legal status or citizenship – except for refugees not permanently settled in the country of
asylum, who are generally considered part of the population of the country of origin.
Population, female (% of total): percentage of the population that is female.
Literacy rate, adult total (% of people ≥15 years): percentage of the population aged 15 and above who can, with understanding, read and write a
short, simple statement on their everyday life. Generally, ‘literacy’ also encompasses ‘numeracy’, the ability to make simple arithmetic calculations. This
indicator is calculated by dividing the number of literates aged 15 years and over by the corresponding age group population and multiplying the result
by 100.
Mortality rate, infant (per 1000 live births): number of infants dying before reaching one-year of age, per 1000 live births in a given year.
GDP per capita (current US$): GDP per capita is gross domestic product divided by midyear population. GDP is the sum of gross value added by all
resident producers in the economy plus any product taxes and minus any subsidies not included in the value of the products. It is calculated without
making deductions for depreciation of fabricated assets or for depletion and degradation of natural resources. Data are in current US dollars.
Unemployment, male (% of male labor force): share of the labor force that is without work but available for and seeking employment.
NA, data not available; GDP, gross domestic product.

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 L. A. Sposato et al.
aging studies, two 8-Slice General Electric Lightspeed® computed
tomography (CT) scanners (General Electric Medical Systems,
Milwaukee, WI, USA) are located at one of the private hospitals
and at a facility separated by less than 1 km from the three hospitals
(‘Resonancia del Centro’). A third CT scanner is available at the
public hospital (Elscint CT-Twin flash, Philips, Amsterdam, the
Netherlands). For the purpose of the study, we will be using a 1·5-T
General Electric Horizon magnetic resonance imaging (MRI)
scanner (General Electric Medical Systems, Milwaukee, WI, USA),
which is located in Resonancia del Centro. A second MRI scanner
(0·23-T General Electric Profile scanner, General Electric Medical
Systems, Milwaukee, WI, USA), which is set at one of the private
hospitals, will be used only if the first one is out of order.
More details about Tandil and PREVISTA study can be found at
the study website (http://www.previstastudy.org).
Patients
The study will enroll all new (incident) and recurrent consecutive
events of stroke or TIA in the City of Tandil, Argentina using
overlapping data sources between May 1, 2013 and April 30, 2015.
The study population will comprise the following categories of
incident and recurrent cerebrovascular events: (1) ischemic
strokes (IS), (2) nontraumatic primary intracerebral haemor-
rhages (PICH), (3) subarachnoid haemorrhages (SAH), and
(4) TIAs. All new events will be initially assessed and classified by
a field neurologist as: (1) probable, (2) possible, and (3) unlikely.
Two board-certified neurologists will adjudicate the events as:
(1) confirmed IS, (2) confirmed PICH, (3) confirmed SAH,
(4) confirmed TIA, (5) stroke of unknown pathological subtype,
and (6) nonstroke. Patients referred from another city seeking
Fig. 1 Case ascertainment and follow-up. ER, emergency room; GW, general ward; CCU, coronary care unit; ICU, intensive care unit; cath lab, catheter
laboratory.
© 2013 The Authors.
International Journal of Stroke © 2013 World Stroke Organization
Protocols
stroke care or those without a permanent address in Tandil (less
than 12 months of residency in the city) during the study period
will not be included in the study.
Case ascertainment
The three Tandilean hospitals will be enrolling incident and
recurrent stroke/TIA patients. Also, general practitioners were
contacted for participating in the study. To ensure inclusion of all
events during the recruitment period of two-years, we will estab-
lish an ‘intensive stroke/TIA-screening program’ (ISP) (hot
pursuit), which consists of a comprehensive daily tracking
program of every potential vascular event including stroke/TIA at
three levels (Fig. 1): (1) events admitted to three Tandilean hos-
pitals: admissions and discharges to/from every service in the
three hospitals (emergency room, general ward, intensive care
unit, coronary care unit, and cath. Lab); (2) nonfatal community
events: (a) consultations in the 10 available ambulatory care
centers; (b) list of patients undergoing ambulatory brain CT or
MRI scanning; (c) lists of patients scheduled for echocardiogra-
phy and carotid Doppler ultrasound; and (d) admissions to reha-
bilitation or tertiary care centers; and (3) fatal community events:
daily search for any suspected stroke-related death through revi-
sion of death certificates at funeral homes and local offices of vital
statistics.
For enhancing recruitment of patients at the ambulatory level,
we have encouraged general practitioners and cardiologists to
refer any patient with symptoms potentially associated with
stroke or TIA to the neurologists at each outpatient clinic. The
study coordinator will also visit the 10 outpatient clinics in the
city on a weekly basis with the aim of sustaining awareness along
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 Protocols
time. Furthermore, an awareness campaign on stroke signs and
symptoms will be simultaneously starting with the ISP program
beginning in April 2013. This campaign will comprise the distri-
bution of flyers and posters in public areas and interviews in local
newspapers, magazines, television, and radio.
With regard to fatal community events, there are two funeral
homes and two local offices of vital statistics in Tandil that have
agreed to make their data readily available for the investigators.
The study coordinator will retrieve death certificates weekly and
will record every death and its cause in the study database. Two
certified neurologists will assess the cause of death in every case in
order to identify potential cerebrovascular events, and verbal
autopsies will be used to investigate every case of suspected stroke
(21). A prespecified verbal autopsy form will be used for deter-
mining if the cause of death was a stroke. For those cases in which
a stroke is suspected as the cause of death, medical records will we
reviewed if available (23).
Estimated study population
On the basis of a previous two-month pilot study performed by
our team in Tandil and based on the analysis of 30 population-
based stroke incidence studies from other countries performed in
the last decade, the estimated number of patients to be included
during the two-year recruitment period is 730, being 504 incident
strokes, 154 recurrent strokes and TIAs (137 strokes and 17 TIAs),
and 72 incident TIAs (8) (Fig. 2).
Definitions and classification of cerebrovascular
events and mortality
Every patient will undergo neuroimaging studies with the aim of
classifying stroke types (ischemia vs. haemorrhage). A head CT
Fig. 2 Estimated recruitment rate.
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L. A. Sposato et al.
scan will be done within the first 72 hours. MRI will be also done
whenever possible. Strokes of patients not being able to undergo
neuroimaging studies will be classified as of ‘unknown type’.
Cerebrovascular events will be defined according to the standard
WHO definition (21,24). IS will be defined as a focal neurological
impairment of sudden onset, and lasting more than 24 hours (or
leading to death), and of presumed vascular origin (21,24). TIA
will be defined as a focal (or at times global) neurological or
retinal impairment of sudden onset, and lasting less than 24 hours,
and of presumed vascular origin (21,24). PICH will be defined as
a permanent episode of neurological dysfunction caused by a
parenchymal brain haemorrhage evidenced on neuroimaging
studies, regardless of duration of symptoms (21,24). Cerebrovas-
cular events will be classified as SAH in the presence of typical
symptoms (e.g. headache, nausea, vomiting, decreased alertness)
with evidence of blood in the subarachnoid space as noted
by neuroimaging studies (CT/MRI), cerebrospinal fluid (CSF)
examination or autopsy, irrespective of symptoms duration.
Subjects with stroke or TIA will be considered as incident (first
ever in a lifetime stroke or TIA) in the absence of a clinical history
of stroke independent of CT/MRI findings. Stroke patients with a
history of TIA who develop subsequent stroke will be regarded as
incident strokes. After the exclusion of other potential causes of
neurological deterioration, we will define a stroke or a TIA as
recurrent if a period of neurological stability of ≥24 hours is
demonstrated between the index stroke and the subsequent cere-
brovascular event (25). IS and TIAs will be further classified
according to Trial of ORG 10172 in Acute Stroke Treatment
(TOAST) criteria (26) and according to Oxfordshire Classifica-
tion (27). TOAST criteria will be used for stratifying IS into five
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International Journal of Stroke © 2013 World Stroke Organization
 L. A. Sposato et al.
different pathophysiological subtypes: (1) large vessel atheroscle-
rosis, (2) cardioembolism, (3) small vessel occlusion, (4) stroke of
other determined etiology, and (5) stroke of undetermined etiol-
ogy (two or more causes identified, negative evaluation or incom-
plete assessment). Oxfordshire Classification will be used for
categorizing strokes into: (1) total anterior circulation infarction,
(2) partial anterior circulation infarction, (3) lacunar infarction,
and (4) posterior circulation infarction.
Death will be categorized as: (1) neurological (herniation,
edema, hydrocephalus, raised intracranial pressure, and recurrent
stroke); (2) pneumonia (or any other chest infection); (3) other
infections leading to death (urinary tract infection, infective
endocarditis, sepsis of any other cause); (4) cardio-respiratory
(myocardial infarction, congestive heart failure, sudden death,
acute respiratory distress syndrome, and pulmonary embolism);
(5) other causes (accident, cancer, and acquired immunodefi-
ciency syndrome); and (6) unknown. Deaths will be also classified
as vascular (consequences of qualifying or recurrent stroke, myo-
cardial infarction, congestive heart failure, sudden death, and pul-
monary embolism) or nonvascular (any other cause). Causes of
death will be adjudicated by an ad hoc committee comprised by
two certified neurologists and two certified cardiologists.
Data collection
Patients will be assessed upon enrollment (day 0 after stroke/
TIA), at day 28, and at 6 and 12 months. Data will be collected in
a printed case report form (CRF, supplementary file in Spanish).
This information will be subsequently recorded in an electronic,
web-based, anonymized, and encrypted database developed by
Kinetica Solutions® (Buenos Aires, Argentina), which will be
stored in Windows Azure®, Microsoft’s cloud platform
(Redmond, WA, USA). The investigator’s manual with definitions
for every variable and few operational hints (Supplementary file,
in Spanish) is included in the printed CRF.
Data will be initially collected during hospital stay. Written
informed consent will be obtained from the patient or the closest
family member or legal guardian.
Follow-up will be undertaken at 28 days, 6, and 12 months by
using prescheduled telephone interviews. In order to minimize
delays in case of off days, vacations, or pregnancy, three physicians
will be responsible for doing these interviews. For those cases in
which patients are not able to speak on the phone (i.e. aphasia,
tracheostomy, death), a family member will be asked to respond
to the questions.
As not all participating neurologists are certified or familiar
with the administration of the national institutes of Health Stroke
Scale (NIHSS), stroke severity will be determined by quantifying
the number of neurological deficits (28,29) by using the 6S Score
(30), as done in other stroke registries. The 6S score has good
correlation with the NIHSS, in-hospital mortality, and neurologi-
cal worsening during hospital stay (30).
As mentioned, before, every patient will undergo brain CT or
MRI scanning. Participants will be assessed according to the usual
protocol for stroke patients when possible (e.g. carotid Doppler
ultrasound, magnetic resonance angiography, transthoracic, or
transesophageal echocardiography). Neuroimaging studies will
© 2013 The Authors.
International Journal of Stroke © 2013 World Stroke Organization
Protocols
be evaluated by two certified neurologists and will be stored for
further analyses.
The CRF will comprise data on: (1) anonymized administrative
information, (2) time of stroke/TIA onset, (3) socioeconomic
status, (4) presenting signs and symptoms, (5) vascular risk
factors, (6) previous use of antithrombotic drugs, and (7) modi-
fied Rankin Scale at 28 days, 6, and 12 months.
Statistical analysis
For enabling future comparisons, PREVISTA will use a similar
statistical approach as that of Proyecto Investigación de Stroke en
Chile: Iquique Stroke Study (PISCIS) Project (9). We will calculate
incidence rates using the population of the city of Tandil as de-
nominator based on the 2010 Census (123 871 inhabitants) (19).
Incidence rates of first-ever strokes will be adjusted to Argen-
tine population by the direct method (19) and by using the WHO
World population by the direct method (31). Data will also be
stratified by age (decades of life), gender, subtypes of stroke,
TOAST classification, and socioeconomic status. Data will be
stratified according to gender and decades of life.
We will calculate confidence intervals for crude rates and for
specific rates for age and gender on the assumption of a normal
distribution for counts greater than 100 and Poisson distribution
for counts less than 100. Confidence intervals for age-adjusted
rates will be calculated according to the formula proposed by
Keyfitz (32). The χ2 and Fisher’s exact tests will be used to
compare categorical variables, and the Mann–Whitney U-test and
Student’s t-test will be used to compare continuous variables. All
tests will be two tailed.
Ethical considerations
The study will be conducted in accordance with good clinical
practice (GCP), all applicable subject privacy and confidentiality
requirements, and the guiding principles of the declaration of
Helsinki. All subject’s data will be confidential and only autho-
rized individuals will have access to study-related documents.
Written informed consent will be obtained from each subject
prior to participation in the study. The closest family member or
legal guardian will be asked to consent on behalf of the patient if
he/she is unable to do it.
An independent Ethics Committee has approved the study and
the informed consent form. The database will be registered at the
Argentinean National Office for the Protection of Personal Data
(Ministry of Justice and Human Rights).
Organizational structure
PREVISTA study is led by an academic steering committee com-
posed of two cochairs and local and international experts in
stroke and epidemiology. This committee will provide scientific
direction and input, will address policy issues regarding the pro-
tocol, and will meet periodically to assess the trial progress. PRE-
VISTA study has an advisory board comprised by two
international stroke experts who will provide input and guidance
with respect to specific scientific issues (e.g. publication strategy
and quality). A subset of the Steering Committee has overseen the
study protocol and has decided on the final approval of the
primary manuscript. This committee will assess enrolment and
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 Protocols
conduction of the study, and will supervise the publication of
subgroup analyses as ‘threaded publications’ (33). A certified neu-
rologist in Tandil City will be responsible for leading the opera-
tional aspects of the study, functioning as a chief operational
officer or general local coordinator. Every participating center will
have a team of field investigators led by a principal investigator.
Every investigator was trained in GCP, in stroke diagnosis and
treatment, in the use of modified Rankin Scale, and in the inter-
pretation of each of the study variables prior to the initiation of
the study. The local study coordinator will be responsible for
administrative assignments of the study.
Data quality control
A certified neurologist will be in charge of data quality control
with the purpose of ensuring consistency and completeness of
every case (Fig. 1). A case will be closed and restricted for further
changes if CRF is consistent and complete. By contrast, if incon-
sistencies or missing data are detected, a query will be sent to the
study coordinator who will be responsible of contacting the cor-
responding investigator for solving the data quality issue. The
database will be closed after the last patient undergoes quality
control.
Trial administration
The trial will be administered by the INECO Foundation, an
Argentinean nonprofit organization that promotes research,
scientific training of professionals in the field of neuro-
sciences, and community education on the prevention, the early
detection, and the treatment of neurological and psychiatric
diseases.
Results and conclusions reported in this manuscript are those
of the authors and are independent from any funding source or
trial administrator.
Summary and conclusions
The WHO and the UN have made their formal statements on the
need of high quality data on noncommunicable diseases from
low- and middle-income countries. PREVISTA is one of the first
results of this call to action. Our study will provide information
on stroke epidemiology within the population of Tandil, which is
representative of a large proportion of Latin-American countries
with low- and middle-income economies. Thus, PREVISTA may
contribute to reduce this gap in knowledge. Providing actual and
current stroke incidence data will serve as the substrate for devel-
oping of more accurate and efficient health care policies. These
data could help to generate higher stroke awareness among policy
makers, professionals, and the general population. The results of
the Argentinean National Stroke Registry (ReNACer) served as a
source for drafting the first National Stroke ACT by the Argen-
tinean Neurological Society, and the results of PREVISTA could
help to reinforce the enactment of this law, as well to promote of
new provincial initiatives. Additionally, by gathering data on spe-
cific risk factors profiles in a Latin-American population, it will be
possible to develop more efficient prevention strategies. Finally,
PREVISTA could provide a useful model for stroke studies in
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L. A. Sposato et al.
other low- and middle-income countries within and beyond
Latin America.
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Supporting Information
Additional Supporting Information may be found in the online
version of this article at the publisher’s web-site:
Appendix S1. Case report form and Investigators manual (in
Spanish).
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