Impact of the coronavirus disease 2019 pandemic on stroke teleconsultations in Germany in the first half of 2020

Abstract

Background and purpose The effects of the coronavirus disease 2019 (COVID‐19) pandemic on telemedical care have not been described on a national level. Thus, we investigated the medical stroke treatment situation before, during, and after the first lockdown in Germany. Methods In this nationwide, multicenter study, data from 14 telemedical networks including 31 network centers and 155 spoke hospitals covering large parts of Germany were analyzed regarding patients' characteristics, stroke type/severity, and acute stroke treatment. A survey focusing on potential shortcomings of in‐hospital and (telemedical) stroke care during the pandemic was conducted. Results Between January 2018 and June 2020, 67,033 telemedical consultations and 38,895 telemedical stroke consultations were conducted. A significant decline of telemedical ( p < 0.001) and telemedical stroke consultations ( p < 0.001) during the lockdown in March/April 2020 and a reciprocal increase after relaxation of COVID‐19 measures in May/June 2020 were observed. Compared to 2018–2019, neither stroke patients' age ( p = 0.38), gender ( p = 0.44), nor severity of ischemic stroke ( p = 0.32) differed in March/April 2020. Whereas the proportion of ischemic stroke patients for whom endovascular treatment (14.3% vs. 14.6%; p = 0.85) was recommended remained stable, there was a nonsignificant trend toward a lower proportion of recommendation of intravenous thrombolysis during the lockdown (19.0% vs. 22.1%; p = 0.052). Despite the majority of participating network centers treating patients with COVID‐19, there were no relevant shortcomings reported regarding in‐hospital stroke treatment or telemedical stroke care. Conclusions Telemedical stroke care in Germany was able to provide full service despite the COVID‐19 pandemic, but telemedical consultations declined abruptly during the lockdown period and normalized after relaxation of COVID‐19 measures in Germany.

Clinician and patient experience of neurology telephone consultations during the COVID-19 pandemic

“…The absence of a relationship between socioeconomic status and goal achievement may reflect our crude method of quantifying socioeconomic status, the relative affluence of the surrounding areas or a true lack of an effect. Our overall findings on patient and clinician satisfaction are broadly in line with other studies and adds to the body of evidence produced both prior to and as a result of the pandemic [13][14][15][16][17][18][19].…”

“…Four hundred and thirty clinician questionnaires were received from 18 clinicians (2 Clinical Nurse Specialists, 16 Consultant Neurologists), all describing consultations with different patients. Within these, 290 consultations (67%) had a corresponding patient questionnaire (80 postal questionnaires, 210 by telephone); the demographics of responders were not significantly different to non-responders (Table S1, Supplementary Data).…”

“But it's a nice compromise” – Qualitative multi‐centre study of barriers and facilitators to acute telestroke cooperation in a regional stroke network

“…We are aware of several studies both nationally [31][32][33] as well as internationally [34][35][36][37] reporting declines in stroke incidence and/or telestroke consultations during government-mandated lockdowns.…”

Acute stroke care during the COVID‐19 pandemic

“…This decrease was mainly related to patients with clinical presentation of transient ischemic attack and minor stroke, whereas admissions of patients with severe stroke did not decrease [2,3]. Furthermore, a significant reduction of telemedical and telemedical stroke consultations has been reproted during the initial lockdown pandemic period [4]. It has been pointed out that patients themselves, as well as the physicians who treated them, were often hesitant to go to the hospital due to the fear of infection.…”

“…The question of the impact on administration of intravenous thrombolysis (IVT) has also been an issue. A German national study investigating the effects of the COVID‐19 pandemic on telemedical care reported a nonsignificant trend toward a lower proportion of IVT recommendations ( p = 0.052) [4]. Furthermore, a significant decrease for administered IVT has been reported in Italy (26%) [3], China (26.7%, p < 0.0001) [5], and France (43% vs. 51%, p = 0.029) [7] compared to nonpandemic periods.…”