An Example of a Stroke Unit Reshaping in the Context of a Regional Hub and Spoke System in the COVID-19 Era

Candeloro, Elisa; Carimati, Federico; Damavandi, Payam Tabaee; Cariddi, Lucia Princiotta; Banfi, Paola; Clemenzi, Alessandro; Gallazzi, Marco; Mauri, Marina; Rebecchi, Valentina; Baruzzi, Fabio; Giorgianni, Andrea; Tozzi, Matteo; Bianchi, Massimo; Ageno, Walter; Versino, Maurizio

doi:10.3389/fneur.2020.01029

Cited by 4 publications

(19 citation statements)

References 21 publications

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“…For example, most centers observed a reduction in the frequency of admission for AIS [13][14][15][16], while, concerning the indicators of stroke care, some centers did not report substantial modifications [17], while others reported a negative impact of stroke care performances [18,19]. During the outbreak, our regional hub-and-spoke network did not change conversely to other Italian experiences [20]. For example, in our network, before the admission to emergency department, all patients underwent a two-step triage.…”

Section: Discussionmentioning

confidence: 73%

Effect of the COVID-19 pandemic and the lockdown measures on the local stroke network

et al. 2021

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Introduction The COVID-19 outbreak highly impacted the acute ischemic stroke care management. The primary end point of the study was to evaluate the impact of the COVID-19 outbreak and the following lockdown measures on our hub-and-spoke network; the secondary end point was to evaluate if the impact of the COVID-19 outbreak was different in hub-and-spoke centers. Methods This was a retrospective multicenter observational study conducted at the Stroke Units of Policlinico Gemelli, Ospedale San Filippo Neri, Ospedale di Belcolle, and Ospedale San Camillo de Lellis. We collected clinical reports of all consecutive patients admitted with diagnosis of acute ischemic stroke or transient ischemic attack (TIA) during the phase 1 of the lockdown period (11 March 2020-4 May 2020). As controls, we used all consecutive patients admitted for acute ischemic stroke or TIA in the same period of the previous year. Results A total of 156 and 142 clinical reports were collected in 2019 and 2020, respectively. During the COVID-19 outbreak, we observed a reduction of number of thrombolysis, a reduction of the length of hospitalization, and an increase of pneumonia. Regarding performance indicators, we observed an increase in onset-to-door time and in door-to-groin time. We did not observe any statistically significant interaction between year (2019 vs 2020) and facility of admission (hub vs spoke) on all variables analyzed. Discussion Our observational study, involving hub-and-spoke stroke network of a wide regional area, indicates that the COVID-19 outbreak impacted on the acute stroke management. This impact was equally observed in hub as well as in spoke centers.

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Section: Discussionmentioning

confidence: 73%

Effect of the COVID-19 pandemic and the lockdown measures on the local stroke network

et al. 2021

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“…No significant difference was observed in the onset-to-door time between the two groups (p = 0.97), whereas an almost significant difference was observed in the door-to-picture time (p = 0.08). The median door-to-picture time did not differ significantly between patients who were diagnosed using CT (15 [10][11][12][13][14][15][16][17][18][19][20][21] vs. 14 [9][10][11][12][13][14][15][16][17][18][19][20][21] min, p = 0.24) (Fig. 3A).…”

Section: Resultsmentioning

confidence: 99%

“…3B). The median door-to-picture time was longer in patients treated with NPER than in those treated with nER within the study group (47 [27-57] vs. 18 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] min, p = 0.07) (Fig. 4).…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies on the time frames of stroke treatment in the setting of COVID-19 reported that the door-to-picture time was 12-34 min in the pre-COVID-19 period. [14][15][16][17][18][19][20] Our door-to-picture time of 18 min in the study group was within this range, which is considered acceptable. However, it may differ in an area with a particularly severe outbreak of COVID-19; thus, further preparation is required.…”

Section: Interpretation Of the 3-min Delay In The Door-topicture Timementioning

confidence: 99%

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Initial Management of Patients with Suspected Stroke in the SARS-CoV-2 Era: Effects on the Door-to-Picture Time

Yoshimura

Yamaoka

Ishikawa

et al. 2021

JNET

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To examine the effectiveness of a newly developed emergency room (ER) protocol to treat patients with stroke and control the spread of SARS-CoV-2 by evaluating the door-to-picture time.Methods: We retrospectively enrolled 126 patients who were transported to our ER by ambulance with suspected stroke between April 15 and October 31, 2020 (study group). A risk judgment system named the COVID level was introduced to classify the risk of infection as follows: level 0, no infection; I, infection unlikely; II, possible; III, probable; and IV, definite. Patients with COVID levels 0, I, or II and a Glasgow Coma Scale (GCS) score >10 were placed in a normal ER (nER) without atmospheric pressure control; the medical staff wore standard personal protective equipment (PPE) in such cases. Patients with COVID level II, III, or IV, and a GCS score of ≤10 were assigned to the negative pressure ER (NPER); the medical staff wore enhanced PPE for these cases. The validity of the protocol was assessed. The door-to-picture time of the study group was compared with that of 114 control patients who were transported with suspected stroke during the same period in 2019 (control group). The difference in the time for CT and MRI between the two groups was also compared. In the study group, the time spent in the nER and NPER was evaluated.Results: In all, 118 patients (93.7%) were classified as level I, 6 (4.8%) as level II, and 2 (1.6%) as level III. Only five patients (4.0%) were treated with NPER. Polymerase chain reaction tests were performed on 118 out of 126 patients (93.7%) and were negative. No significant differences were observed in age, sex, neurological severity, modalities of diagnostic imaging, and diagnosis compared with the control group. The median door-to-picture time was 18 (11-27.8) min in the study group and 15 (10-25) min in the control group (p = 0.08). No delay was found on vs. 14 [9-21] min, p = 0.24). In contrast, there was an 8-min delay for MRI (30 [21.8-50] vs. 22 [14-30] min, p = 0.01). The median door-to-picture time was 29 min longer in patients treated with NPER than in those treated with nER, although the difference was not significant due to the small number of patients (47 [27-57] vs. 18 [11-26] min, p = 0.07). Conclusion:Our protocol could optimize the use of medical resources with only a 3-min delay in the door-to-picture time in an area without explosive outbreak. Unfortunately, the effectiveness of the protocol in preventing infection could not be verified because of the low incidence of COVID-19. When developing and modifying an institutional protocol, recognizing the outbreak status surrounding each institution is important.

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“…Italian neurologists and allied professionals have soon responded to the consequences of the pandemic, dealing not only with the reorganization of neurological emergency units, chiefly stroke units and networks [24][25][26], but also providing activities in the newborn COVID units. Telemedicine, including telephone follow-up consultations and remote patient monitoring, has been used to preserve care continuity [27][28][29][30].…”

Section: Reflecting On Neurological Preparednessmentioning

confidence: 99%

The impact of the COVID-19 pandemic on people with neurological disorders: an urgent need to enhance the health care system’s preparedness

et al. 2021

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An Example of a Stroke Unit Reshaping in the Context of a Regional Hub and Spoke System in the COVID-19 Era

Cited by 4 publications

References 21 publications

Effect of the COVID-19 pandemic and the lockdown measures on the local stroke network

Effect of the COVID-19 pandemic and the lockdown measures on the local stroke network

Initial Management of Patients with Suspected Stroke in the SARS-CoV-2 Era: Effects on the Door-to-Picture Time

The impact of the COVID-19 pandemic on people with neurological disorders: an urgent need to enhance the health care system’s preparedness

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