Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan

Fuentes, Blanca; Leciñana, M. Alonso de; Calleja-Castaño, Patricia; Carneado-Ruiz, J; Egido-Herrero, J A; Gil‐Núñez, A.; Masjuan-Vallejo, Jaime; Vivancos-Mora, J; Rodríguez‐Pardo, Jorge; Riera-López, N.; Ximénez-Carrillo, Álvaro; Cruz-Culebras, A; Gómez-Escalonilla, Carlos; Díez‐Tejedor, Exuperio

doi:10.1016/j.nrleng.2020.05.013

Cited by 15 publications

(16 citation statements)

References 9 publications

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“…26 A recent report from the Madrid Stroke Network showed a 12% reduction in the number of stroke code activations through the 112-EMS, a figure that is within the monthly SD range of the last 2 years. 7 In this multicenter analysis, no significant reduction in the number of patients with acute stroke arriving at the hospital by their own transport or dispatched by the EMS was found during the first 2 months of the COVID-19 outbreak. We also found a high rate of reperfusion therapies in patients with CI in our cohort (43.3%) without differences regarding COVID-19 diagnosis; door-to-imaging, door-to-needle, and DTP times in the whole cohort were within the recommended ranges.…”

Section: Discussionmentioning

confidence: 67%

“…The admission of patients with transient ischemic attack or minor stroke was avoided, promoting urgent diagnostic protocols and follow-up by telemedicine. 3,7 We collected demographic data, comorbidities, prestroke treatments, date of stroke onset, date and type of hospital arrival, stroke severity according to the National Institutes of Health Stroke Scale score, door-to-imaging time, neuroimaging findings, recanalization treatments, door-to-needle time if intravenous thrombolysis, door-to-puncture (DTP) time if EVT, time elapsed between stroke and diagnosis of COVID-19, chest CT findings, treatments received for COVID-19, laboratory data, in-hospital complications, final stroke diagnosis, and modified Rankin Scale at discharge. Modified Rankin Scale scores of 3 to 6 were categorized as death or dependence.…”

Section: Methodsmentioning

confidence: 99%

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Stroke Acute Management and Outcomes During the COVID-19 Outbreak

Fuentes

Leciñana

García-Madrona

et al. 2021

Stroke

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Background and Purpose: The coronavirus disease 2019 (COVID-19) outbreak has added challenges to providing quality acute stroke care due to the reallocation of stroke resources to COVID-19. Case series suggest that patients with COVID-19 have more severe strokes; however, no large series have compared stroke outcomes with contemporary non–COVID-19 patients. Purpose was to analyze the impact of COVID-19 pandemic in stroke care and to evaluate stroke outcomes according to the diagnosis of COVID-19. Methods: Retrospective multicenter cohort study including consecutive acute stroke patients admitted to 7 stroke centers from February 25 to April 25, 2020 (first 2 months of the COVID-19 outbreak in Madrid). The quality of stroke care was measured by the number of admissions, recanalization treatments, and time metrics. The primary outcome was death or dependence at discharge. Results: A total of 550 acute stroke patients were admitted. A significant reduction in the number of admissions and secondary interhospital transfers was found. COVID-19 was confirmed in 105 (19.1%) patients, and a further 19 patients were managed as suspected COVID-19 (3.5%). No differences were found in the rates of reperfusion therapies in ischemic strokes (45.5% non–COVID-19, 35.7% confirmed COVID-19, and 40% suspected COVID-19; P =0.265). However, the COVID-19 group had longer median door-to-puncture time (110 versus 80 minutes), which was associated with the performance of chest computed tomography. Multivariate analysis confirmed poorer outcomes for confirmed or suspected COVID-19 (adjusted odds ratios, 2.05 [95% CI, 1.12–3.76] and 3.56 [95% CI, 1.15–11.05], respectively). Conclusions: This study confirms that patients with COVID-19 have more severe strokes and poorer outcomes despite similar acute management. A well-established stroke care network helps to diminish the impact of such an outbreak in stroke care, reducing secondary transfers and allowing maintenance of reperfusion therapies, with a minor impact on door-to-puncture times, which were longer in patients who underwent chest computed tomography.

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Section: Discussionmentioning

confidence: 67%

Section: Methodsmentioning

confidence: 99%

Stroke Acute Management and Outcomes During the COVID-19 Outbreak

Fuentes

Leciñana

García-Madrona

et al. 2021

Stroke

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“…The Madrid Stroke Network provides acute stroke care for approximately 6.5 million inhabitants, and seven hospitals are MT‐ready on a weekly rotation basis, ensuring that three hospitals provide full‐time coverage every day. During the first wave of the pandemic, some organizational changes to secure stroke care provision were arranged [ 12 , 13 ]. Briefly, they included protocols to ensure access to hospital care; measures for the early recognition of COVID‐19‐positive patients; the organization of specific pathways for infected and non‐infected patients; the avoidance of unnecessary diagnostic procedures that could increase the risk of contagion; and early discharge.…”

Section: Introductionmentioning

confidence: 99%

Fewer COVID‐19‐associated strokes and reduced severity during the second COVID‐19 wave: The Madrid Stroke Network

Fuentes

Leciñana

Rigual

et al. 2021

Euro J of Neurology

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Background and purpose:The experience gained during the first COVID-19 wave could have mitigated the negative impact on stroke care in the following waves. Our aims were to analyze the characteristics and outcomes of patients with stroke admitted during the second COVID-19 wave and to evaluate the differences in the stroke care provision compared with the first wave. Methods: This retrospective multicenter cohort study included consecutive stroke patients admitted to any of the seven hospitals with stroke units (SUs) and endovascular treatment facilities in the Madrid Health Region. The characteristics of the stroke patients with or without a COVID-19 diagnosis were compared and the organizational changes in stroke care between the first wave (25 February to 25 April 2020) and second wave (21 July to 21 November 2020) were analyzed.Results: A total of 550 and 1191 stroke patients were admitted during the first and second COVID-19 waves, respectively, with an average daily admission rate of nine patients in both waves. During the second wave, there was a decrease in stroke severity (median National Institutes of Health Stroke Scale 5 vs. 6; p = 0.000), in-hospital strokes (3% vs. 8.1%) and in-hospital mortality (9.9% vs. 15.9%). Furthermore, fewer patients experienced concurrent , and they presented milder COVID-19 and less severe strokes. Fewer hospitals reported a reduction in the number of SU beds or deployment of SU personnel to COVID-19 dedicated wards during the second wave. Conclusions:During the second COVID-19 wave, fewer stroke patients were diagnosed with COVID-19, and they had less stroke severity and milder COVID-19.

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“…Furthermore, patients have limited or reduced attendance at face-to-face consultations for fear of being infected, which may lead to follow-up problems, cancellation of diagnostic tests or delay in requesting initial specialist visits 12,13 .…”

Section: Impact Of Covid-19 Infection For Osteoporosis Out-patient Clinicsmentioning

confidence: 99%

Perfil asistencial del paciente con osteoporosis tributario de visita de telemedicina en la era post-COVID-19

Cancio

Capdevila-Reniu

Casanova

et al. 2021

Rev Osteoporos Metab Miner

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Objetive: Define the profile of the candidate and non-candidate osteoporosis patient for assistance in osteoporosis teleconsultation, in the post-COVID-19 era. Proposal of a management protocol for outpatient follow-up. Methods: We have carried out a bibliographic review through a systematic search in the Pubmed.gov databases of the available evidence of articles in English and Spanish with an inclusion date until October 2020, following the recommendations of the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation). Database is aimed at locating and accessing relevant information for this review in an updated way. Results: The profile of the patient candidate for teleconsultation would be of those who present a history of osteoporosis, previously diagnosed, with treatment and requiring follow-up. COVID-19 has occurred in a context in which the main causes of mortality are chronic diseases and the need to protect against transmission. Conclusions: We propose a consensus for managing this patient, with differentiated sections for the different stages of the telematic care process. This will help in clinical decision-making and also in the process of follow-up and therapeutic adherence and, therefore, in optimal use of healthcare resources.

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Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan

Cited by 15 publications

References 9 publications

Stroke Acute Management and Outcomes During the COVID-19 Outbreak

Stroke Acute Management and Outcomes During the COVID-19 Outbreak

Fewer COVID‐19‐associated strokes and reduced severity during the second COVID‐19 wave: The Madrid Stroke Network

Perfil asistencial del paciente con osteoporosis tributario de visita de telemedicina en la era post-COVID-19

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