Background and Purpose: The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center. Methods: On February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision to refrain from reallocating the Stroke Team and Stroke Unit to the care of patients with COVID-19. From March 1 to March 31, 2020, we measured the number of emergency calls to the Emergency Medical System in Catalonia (7.5 million inhabitants), and the Stroke Codes dispatched to Hospital Clinic of Barcelona. We recorded all stroke admissions, and the adequacy of acute care measures, including the number of thrombectomies, workflow metrics, angiographic results, and clinical outcomes. Data were compared with March 2019 using parametric or nonparametric methods as appropriate. Results: At Hospital Clinic of Barcelona, 1232 patients with COVID-19 were admitted in March 2020, demanding 60% of the hospital bed capacity. Relative to March 2019, the Emergency Medical System had a 330% mean increment in the number of calls (158 005 versus 679 569), but fewer Stroke Code activations (517 versus 426). Stroke admissions (108 versus 83) and the number of thrombectomies (21 versus 16) declined at Hospital Clinic of Barcelona, particularly after lockdown of the population. Younger age was found in stroke admissions during the pandemic (median [interquartile range] 69 [64–73] versus 75 [73–80] years, P =0.009). In-hospital, there were no differences in workflow metrics, angiographic results, complications, or outcomes at discharge. Conclusions: The COVID-19 pandemic reduced by a quarter the stroke admissions and thrombectomies performed at a Comprehensive Stroke Center but did not affect the quality of care metrics. During the lockdown, there was an overload of emergency calls but fewer Stroke Code activations, particularly in elderly patients. Hospital contingency plans, patient transport systems, and population-targeted alerts must act concertedly to better protect the chain of stroke care in times of pandemic.

Strokes are a time-dependent medical emergency. The training of emergency medical service (EMS) professionals is essential to ensure the activation of stroke codes with pre-notification, as well as a rapid transfer to achieve early therapy. New assessment scales for the detection of patients with suspected large vessel occlusion ensures earlier access to endovascular therapy. The aim of this study was to evaluate the impact on an online training intervention focused on the Rapid Arterial oCclusion Evaluation (RACE) scoring of EMS professionals based on the prehospital stroke code in Catalonia from 2014 to 2018 in a pre–post intervention study. All Catalonian EMS professionals and the clinical records from primary stroke patients were included. The Kirkpatrick model guided the evaluation of the intervention. Data were collected on the knowledge on stroke recognition and management, pre-notification compliance, activated stroke codes and time performance of EMS professionals. Knowledge improved significatively in most items and across all categories, reaching a global achievement of 82%. Pre-notification compliance also improved significantly and remained high in the long-term. Increasingly higher notification of RACE scores were recorded from 60% at baseline to 96.3% in 2018, and increased on-site clinical care time and global time were also observed. Therefore, the online training intervention was effective for increasing EMS professionals’ knowledge and pre-notification compliance upon stroke code activation, and the wide adoption of a new prehospital scale for the assessment of stroke severity (i.e., the RACE scale) was achieved.

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Background The global cost associated with substitute treatment for patients with chronic kidney disease has been calculated, but there is a lack of information about the characteristics and costs deriving from pre-hospital care with transport and admission to hospital emergency services. Therefore, the aim of this study was to identify the characteristics of urgent telephone requests to Emergency Medical Services for patients with chronic kidney disease in Catalonia, Spain, and make a cost estimation of prehospital care and admission to the emergency department, grouped by comorbidities. Methods Retrospective longitudinal observational study. Patients who required urgent prehospital care based on telephone triage were enrolled. Sociodemographic, clinical, and financial variables were collected. The data were gathered by means of a review of the clinical records in the Emergency Medical Services database. To explore the possible relation among the qualitative variables the χ² test was used, for the relation between a quantitative variable and dichotomy qualitative variable the student t test was used with prior testing of the normal deviation of quantitative variables, and the Mann-Whitney U test was then employed if they did not fulfil normality criteria. For all calculations an alpha error of p <0.05 was assumed.Results A total of 252 phone calls were analyzed. Some 98.4% of patients (n=248) were prioritized through phone triage and classified as very severely ill: resuscitation or emergencies. The most prevalent initial diagnoses were intense dyspnoea, accidental fall, abdominal pain, and disease decompensation; there were 11 cases of cardio-respiratory arrest (4.36%), half of which were associated with hypertensive heart disease (HHDT). The average cost of prehospital care was €480.06/patient (SD=256.74), but in patients with comorbidities this rose to €550.77 for HHD and €508.73 for diabetes mellitus (DM). No statistically significant differences were found between total cost/patient and comorbidity (p=0.361), or between the costliest comorbidities, HHD and DM (p=0.330). Conclusions Patients telephoned for help when they were in serious condition, in line with the levels established by telephone triage. The cost of prehospital care was high, and this increased in the presence of comorbidities.

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