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

Abstract

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.

Consequences of COVID-19 pandemic lockdown on emergency and stroke care in a German tertiary stroke center

“…On the other hand, while our IVT rate was stable (23.8% vs 24.3% vs 20.6%), which was in contrast to other observations [13,[17][18][19], but in line with the nationwide German cohort study [8], the rate of large vessel occlusion dropped not significantly along with a significant reduction of our EVT rate and absolute number between 2019 and the spring lockdown of EVT by 58 and 62%, respectively. Our observed reduction of EVT is beyond the 21% decline reported from a registry in France [20] or the 23% decline reported from China [9].…”

Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis

“…This may be related to possible delayed hospital arrival and an overall decrease in the absolute number of patients with mild and moderate stroke seeking medical care. 21,29,30,46,54,55,59,60,62,70 However, the likelihood of being treated with IVT did not differ between two periods in comprehensive stroke centers and that of being treated with EVT increased during the pandemic, which might be due to adequate changes made in workflow of acute stroke care in comprehensive stroke centers. 71 Higher likelihood of being treated with EVT might also have been caused by higher likelihood of large vessel occlusions due to prothrombotic state driven by COVID-19 virus, as reported by multiple studies.…”

“…8, Twenty-four studies met criteria for 'good' quality and 13 met criteria for 'fair' quality (Supplemetary Tables 2-4). Most studies compared the pandemic period (ranging from January to June 2020) to a similar period in the preceding year (range January to June 2019) [28][29][30][31]33,35,39,[41][42][43]45,46,[48][49][50]52,[54][55][56][57][58]60 or the months preceding the pandemic (range September 2019 to December 2019). 8,32,34,[36][37][38]40,44,47,51,53,59,[61][62][63]…”

“…The onset-to-door time was reported in 14/37 studies. 29,30,44,46,48,49,52,54,55,[57][58][59]61,63 There was no difference in mean onset-to-door time during pandemic when compared to pre-pandemic period (standardized mean difference=-0.2; 95% CI, -0.8 to 0.3).…”

Social Distancing, Stroke Admissions and Stroke Mortality During the COVID-19 Pandemic: A Multicenter, Longitudinal Study

“…Indeed, some studies have shown that performance of stroke care declined during the pandemic, with increases in door-to-needle and door-to-groin times, and a reduction of intravenous thrombolysis and endovascular therapy procedures. 18 , 26 , 27 , 28 , 29 In one study, delays in stroke therapy were related to increased time from symptom detection to hospital arrival. 30 These findings underline the hypothesis that the drop in stroke admissions probably reflect increased barriers to stroke care.…”