Clinical, neurophysiological and neuroradiological characteristics of 30 cases of SARS-COV-2-associated encephalitis in Lombardia

Abstract

Background and aimsThe COVID-19 pandemic and related restrictions has been disruptive for healthcare systems, especially for time-sensitive emergencies. During the viral outbreak, a reduction of stroke patients' volume in hospitals in Italy and worldwide has been extensively reported, as well as a severe delay in all integrated steps of hyperacute treatments and management. MethodsThis was a single-centre, observational cohort study performed in Careggi University Hospital, a Tertiary Stroke Center with endovascular facilities of the integrated "Hub and Spoke" stroke organisation in Area Vasta Centro of Tuscany. We retrospectively analysed system processes timings, treatment and clinical variables between early pandemic phase (from 1st of March to 30th of April 2020) and pre-pandemic (the same period of 2019), to evaluate the impact of COVID-19 related restrictions on performance metrics and overall stroke care efficiency at our center. ResultsIn 2020 the number of acute stroke patients admitted to our Hospital and those receiving tPA showed a mild decline (114vs94 stroke patients and 22%vs20% receiving rtPA), while the proportion receiving EVT raised (from 23% to 31%, p = 0.190). A slight delay in patients' shipment and treatment administration was generally detected in 2020 (an increase of 45 min p = 0.484 in symptom onset to 1st_Hospital_door_time, 19 min p = 0.192 in door_to_needle and 18 min p = 0.220 in door_to_groin_puncture), but some intrahospital parameters improved regarding during pandemic: mean door to neurological evaluation and to CT Scan timings were significantly lower in 2020 (12minvs0 min, p = 0.005 and 93vs58, p = 0.01, respectively). ConclusionsOverall quality of care performance at our comprehensive stroke center was not affected during lockdown period.