Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown-Reference-Cited by-同舟云学术

Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown

Published:2021-05 Issue:5 Volume:52 Page:1693-1701
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Altersberger Valerian L.¹^ORCID,Stolze Lotte J.²,Heldner Mirjam R.³,Henon Hilde⁴,Martinez-Majander Nicolas⁵^ORCID,Hametner Christian⁶,Nordanstig Annika⁷⁸,Zini Andrea⁹,Nannoni Stefania¹⁰,Gonçalves Bruno¹¹¹²,Nolte Christian H.¹³,Baumgartner Philipp¹⁴,Kastrup Andreas¹⁵,Papanagiotou Panagiotis¹⁵,Kägi Georg¹⁶,Leker Ronen R.¹⁷,Zedde Marialuisa¹⁸,Padovani Alessandro¹⁹,Pezzini Alessandro¹⁹,Padjen Visnja²⁰,Cereda Carlo W.⁴²¹^ORCID,Ntaios Georges²²,Bonati Leo H.¹,Rinkel Leon A.²^ORCID,Fischer Urs³,Scheitz Jan F.¹³,Wegener Susanne¹⁴,Turc Guillaume¹¹,Michel Patrik¹⁰,Gentile Mauro⁹,Rentzos Alexandros⁷⁸^ORCID,Ringleb Peter A.⁶²³,Curtze Sami⁵^ORCID,Cordonnier Charlotte,Arnold Marcel³,Nederkoorn Paul J.²,Engelter Stefan T.¹²⁴^ORCID,Gensicke Henrik²⁴,

Affiliation:

1. Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., L.H.B., S.T.E.).

2. Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (L.J.S., L.A.R., P.J.N.).

3. Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., U.F, M.A.).

4. University Lille, Inserm, CHU Lille, U1172- F-59000, France (H.H., C.C.).

5. Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.C.).

6. Department of Neurology, University Hospital Heidelberg, Germany (C.H., P.A.R.).

7. Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg (A.N., A.R.).

8. Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (A.N., A.R.).

9. IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy (A.Z., M.G.).

10. Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland (S.N., P.M.).

11. Department of Neurology, Sainte-Anne Hospital, Paris, France Université Paris Descartes, France (B.G., G.T.).

12. Niteroi D’Or Hospital, Niteroi, Brazil (B.G.).

13. Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S.).

14. Zurich Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (P.B., S.W.).

15. Departments of Neurology and Neuroradiology, Klinikum Bremen-Mitte, Germany (A.K., P.P.).

16. Department of Neurology, Kantonsspital St. Gallen, Switzerland (G.K.).

17. Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.).

18. Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy (M.Z.).

19. Neurology Section, Department of Clinical and Experimental Sciences, University of Brescia; Neurology Unit, ASST Spedali Civili, Italy (A. Padovani, A. Pezzini).

20. Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia (V.P.).

21. Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland, Lugano (C.W.C.).

22. Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.).

23. Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital and Department of Radiology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Sweden (A.R.).

24. Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (S.T.E., H.G.).

Abstract

Background and Purpose: Timely reperfusion is an important goal in treatment of eligible patients with acute ischemic stroke. However, during the coronavirus disease 2019 (COVID-19) pandemic, prehospital and in-hospital emergency procedures faced unprecedented challenges, which might have caused a decline in the number of acute reperfusion therapy applied and led to a worsening of key quality measures for this treatment during lockdown. Methods: This prospective multicenter cohort study used data from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry of patients with acute ischemic stroke treated with reperfusion therapies, that is, intravenous thrombolysis or endovascular therapy. We compared prehospital and in-hospital time-based performance measures (stroke-onset-to-admission, admission-to-treatment, admission-to-image, and image-to-treatment time) during the first 6 weeks after announcement of lockdown (lockdown period) with the same period in 2019 (reference period). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale) after 24 hours and occurrence of symptomatic intracranial hemorrhage (following the ECASS [European-Australasian Acute Stroke Study]-II criteria). Results: Across 20 stroke centers, 540 patients were treated with intravenous thrombolysis/endovascular therapy during lockdown period compared with 578 patients during reference period (−7% [95% CI, 5%–9%]). Performance measures did not change significantly during the lockdown period (2020/2019 minutes median: onset-to-admission 133/145; admission-to-treatment 51/48). Same was true for admission-to-image (20/19) and image-to-treatment (31/30) time in patients with available time of first image (n=871, 77.9%). Median National Institutes of Health Stroke Scale on admission (2020/2019: 11/11) and after 24 hours (2020/2019: 6/5) and percentage of symptomatic intracranial hemorrhage (2020/2019: 6.2/5.7) did not differ significantly between both periods. Conclusions: The COVID-19 pandemic lockdown resulted in a mild decline in the number of patients with stroke treated with acute reperfusion therapies. More importantly, the solid stability of key quality performance measures between the 2020 and 2019 period may indicate resilience of acute stroke care service during the lockdown, at least in well-established European stroke centers.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Link

https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.032176

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