Acute Stroke Management During the COVID-19 Pandemic

Hajdu, Steven D.; Pittet, Valérie; Puccinelli, Francesco; Hassen, Wagih Ben; Maacha, Malek Ben; Blanc, Raphaël; Bracco, Sandra; Broocks, Gabriel; Bartolini, Bruno; Casseri, Tommaso; Clarençon, Frédéric; Naggara, Olivier; Eugène, François; Ferré, Jean-Christophe; Guédon, Alexis; Houdart, Emmanuel; Krings, Timo; Lehmann, P.; Limbucci, Nicola; Machi, Paolo; Macho, Juan; Mandruzzato, Nicolo; Nappini, Sergio; Nawka, Marie Teresa; Nicholson, Patrick; Marto, João Pedro; Pereira, Vítor Mendes; Correia, Manuel; Pinho‐e‐Melo, Teresa; Ramos, João Nuno; Raz, Eytan; Ferreira, Patrı́cia; Reis, João Carlos R.; Shapiro, Maksim; Shotar, Eimad; Horn, Noel van; Piotin, Michel; Saliou, Guillaume

doi:10.1161/strokeaha.120.030794

Cited by 51 publications

(27 citation statements)

References 12 publications

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“…During the pandemic, one major negative impact on acute care for stroke was the decline in emergency hospital admissions, consistent with reports in different regions in China or other countries. The degree of reduction varied from 10 to 70% (11,13,13,(16)(17)(18)(19)(26)(27)(28)(29)(30)(31). One recent report in China also reported a 40% reduction in stroke hospital admissions (16), similar to our results (45.6%).…”

Section: Discussionsupporting

confidence: 89%

“…Our study also examined the question whether there was a delay in emergency care for AIS. In the previous reports, significant delays happened in prehospital stage (14,34), but whether there were delays in workflow metrics during the acute care was conflict (13,14,26,28). According to our results, in the prehospital stage, the OTD time became shorter in the lockdown period, which may benefit from the better traffic situation.…”

Section: Discussionsupporting

confidence: 50%

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Reductions in Hospital Admissions and Delays in Acute Stroke Care During the Pandemic of COVID-19

Chen

Wang

et al. 2020

Front. Neurol.

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Background: Rapid and effective medical care for stroke is paramount to achieve maximal functional recovery. Because of the wide spreading of the coronavirus disease in 2019 (COVID-19), acute stroke care is negatively impacted. How much acute care for stroke has been affected during the pandemic remains to be assessed. Methods: The first-level response to major public health was launched from January 24th to April 29th, 2020 in Beijing to contain the spread of COVID-19. Based on a database connecting all 77 stroke centers, the quantity and quality in emergency care for stroke during the 97 lockdown days were compared with the equivalent period in 2019. During the pandemic, 15 of the 77 stroke centers were designated to receive patients sick with COVID-19. Subgroup analyses were carried out by different types of hospitals (designated and undesignated). Results: There were 1,281 and 2,354 stroke emergency hospital admissions in the lockdown period and the parallel period in 2019, respectively. A reduction of 45.6% in admission was shown in the lockdown period, with more reductions for hemorrhagic stroke (69.0%) compared with ischemic stroke (42.9%). More reductions happened in COVID-19 designated hospitals (52.6%) compared with undesignated hospitals (41.8%). The mean NIHSS score at hospital arrival was significantly higher in the lockdown period (9.4 ± 7.7 in 2020 vs. 8.4 ± 7.8 in 2019, P < 0.001). For the metrics measuring the quality of acute stroke care, the onset to door (OTD), onset to needle (ONT), and onset to recanalization (OTR) times didn't change significantly, while significant delays are shown for the door to CT scan (DTC, 1 min delay), door to needle (DTN, 4 min delays), and door to puncture (DTP, 29 min delays) times, which mainly happened in COVID-19 undesignated hospitals. Conclusions: Profound reductions in stroke hospital admissions and significant delays in emergency care for acute ischemic stroke occurred during the pandemic of COVID-19. Engagement and effective communication with all stakeholders including patients, health care providers, governmental policymakers, and other implementation partners are required for future success in similar crises.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 50%

Reductions in Hospital Admissions and Delays in Acute Stroke Care During the Pandemic of COVID-19

Chen

Wang

et al. 2020

Front. Neurol.

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“…However, this difference was not significant when patients underwent thrombectomy at the first hospital that they presented to [7]. A study of 17 thrombectomy centres in Europe, Canada and the USA showed a significant decrease in the number of thrombectomies performed and an increase in stroke onset-to groin puncture after confinement measures were put in place [14].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

et al. 2020

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Introduction The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. Methods This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). Results There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. Conclusions During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.

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“…As people continue to adjust to social distancing, a shift in the epidemiology of stroke and other medical conditions will most likely be observed, as is being seen in myocardial infarction [29] and in other countries [30][31][32][33][34][35][36][37] in the context of acute ischemic stroke. Although there is evidence to suggest a high rate of cerebrovascular complications in patients with SARS-CoV-2 infection [38][39][40][41][42][43], anecdotal reports indicate a falling rate of new ischemic stroke admissions [30][31][32]34,37,[44][45][46][47][48], stroke code activations [30,36,[49][50][51][52][53], imaging numbers [44,45], and diagnoses [45].…”

Section: Decrease In Ischemic Stroke Patientsmentioning

confidence: 99%

“…Additionally, decreases in acute ischemic stroke treatment numbers have been noted for both thrombolysis [46,53,56,57] and EVT [30,33,47,53,56], with an excellent meta-analysis presented by July et al [53], including data from nine studies [30,56,[58][59][60][61][62][63][64]. Details of each of these studies, as well as other related studies [65,66], can be found in Table S2 (Multimedia Appendix 1).…”

Section: Decrease In Ischemic Stroke Patientsmentioning

confidence: 99%

Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?

Dula¹,

Brown²,

Aggarwal³

et al. 2020

JMIR Aging

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Despite the evidence suggesting a high rate of cerebrovascular complications in patients with SARS-CoV-2, reports have indicated decreasing rates of new ischemic stroke diagnoses during the COVID-19 pandemic. The observed decrease in emergency department (ED) visits is unsurprising during this major crisis, as patients are likely to prioritize avoiding exposure to SARS-CoV-2 over addressing what they may perceive as mild symptoms of headache, lethargy, difficulty speaking, and numbness. In the central and south Texas regions where we practice, we suspect that patient admission, treatment, and discharge volumes for acute stroke treatment have decreased significantly since COVID-19–related shelter-at-home orders were issued. Symptoms of stroke are frequently noticed by a family member, friend, or community member before they are recognized by the patients themselves, and these symptoms may be going unnoticed due to limited face-to-face encounters. This possibility emphasizes the importance of patient education regarding stroke warning signs and symptoms during the current period of isolation and social-distancing. The south Texas population, already saddled with above-average rates of cardiovascular and cerebrovascular disease, has a higher stroke mortality rate compared to Texas and U.S. averages; however, the number of patients presenting to EDs with acute ischemic stroke diagnoses is lower than average. In our viewpoint, we aim to present the relative literature to date and outline our ongoing analyses of the highly affected and diverse stroke populations in San Antonio and Austin, Texas, to answer a simple question: where did all our stroke patients go?

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Acute Stroke Management During the COVID-19 Pandemic

Cited by 51 publications

References 12 publications

Reductions in Hospital Admissions and Delays in Acute Stroke Care During the Pandemic of COVID-19

Reductions in Hospital Admissions and Delays in Acute Stroke Care During the Pandemic of COVID-19

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?

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