Modification of Acute Stroke Pathway in Korea After the Coronavirus Disease 2019 Outbreak

Kim, Tae Jung; Kim, Beom Joon; Gwak, Dong Seok; Lee, Ji Sung; Kim, Jun Yup; Lee, Keon Joo; Kwon, Jung Ah; Shim, Dong Hyun; Kim, Yongwon; Kang, Min Kyoung; Lee, Eung Jun; Nam, Ki Woong; Bae, Jeonghoon; Jeon, Kipyoung; Jeong, Hawoong; Jung, Keun Hwa; Hwang, Younghun; Bae, Hee Joon; Yoon, Byung Woo; Ko, Sang‐Bae

doi:10.3389/fneur.2020.597785

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…No significant difference was observed in the onset-to-door time between the two groups (p = 0.97), whereas an almost significant difference was observed in the door-to-picture time (p = 0.08). The median door-to-picture time did not differ significantly between patients who were diagnosed using CT (15 [10][11][12][13][14][15][16][17][18][19][20][21] vs. 14 [9][10][11][12][13][14][15][16][17][18][19][20][21] min, p = 0.24) (Fig. 3A).…”

Section: Resultsmentioning

confidence: 99%

“…3B). The median door-to-picture time was longer in patients treated with NPER than in those treated with nER within the study group (47 [27-57] vs. 18 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] min, p = 0.07) (Fig. 4).…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies on the time frames of stroke treatment in the setting of COVID-19 reported that the door-to-picture time was 12-34 min in the pre-COVID-19 period. [14][15][16][17][18][19][20] Our door-to-picture time of 18 min in the study group was within this range, which is considered acceptable. However, it may differ in an area with a particularly severe outbreak of COVID-19; thus, further preparation is required.…”

Section: Interpretation Of the 3-min Delay In The Door-topicture Timementioning

confidence: 99%

“…Studies on workflow time intervals and the functional outcomes of patients with LVO are accumulating. [14][15][16][17][18][19][20] Contrary to expectations, there is no certain tendency on the door-topicture times. Chowdhury et al performed an international global survey to gather and summarize information from tertiary care stroke centers on periprocedural pathways and the endovascular management of patients with acute ischemic stroke during the COVID-19 pandemic.…”

Section: Interpretation Of the 3-min Delay In The Door-topicture Timementioning

confidence: 99%

“…Box-and-whisker plots are presented. The median door-to-picture time in the study group was significantly longer than that in the control group by 8 min (30[21.8-50] vs. 22[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], p = 0.01). † Significantly different according to the Mann-Whitney U-test.…”

mentioning

confidence: 99%

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Initial Management of Patients with Suspected Stroke in the SARS-CoV-2 Era: Effects on the Door-to-Picture Time

Yoshimura

Yamaoka

Ishikawa

et al. 2021

JNET

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To examine the effectiveness of a newly developed emergency room (ER) protocol to treat patients with stroke and control the spread of SARS-CoV-2 by evaluating the door-to-picture time.Methods: We retrospectively enrolled 126 patients who were transported to our ER by ambulance with suspected stroke between April 15 and October 31, 2020 (study group). A risk judgment system named the COVID level was introduced to classify the risk of infection as follows: level 0, no infection; I, infection unlikely; II, possible; III, probable; and IV, definite. Patients with COVID levels 0, I, or II and a Glasgow Coma Scale (GCS) score >10 were placed in a normal ER (nER) without atmospheric pressure control; the medical staff wore standard personal protective equipment (PPE) in such cases. Patients with COVID level II, III, or IV, and a GCS score of ≤10 were assigned to the negative pressure ER (NPER); the medical staff wore enhanced PPE for these cases. The validity of the protocol was assessed. The door-to-picture time of the study group was compared with that of 114 control patients who were transported with suspected stroke during the same period in 2019 (control group). The difference in the time for CT and MRI between the two groups was also compared. In the study group, the time spent in the nER and NPER was evaluated.Results: In all, 118 patients (93.7%) were classified as level I, 6 (4.8%) as level II, and 2 (1.6%) as level III. Only five patients (4.0%) were treated with NPER. Polymerase chain reaction tests were performed on 118 out of 126 patients (93.7%) and were negative. No significant differences were observed in age, sex, neurological severity, modalities of diagnostic imaging, and diagnosis compared with the control group. The median door-to-picture time was 18 (11-27.8) min in the study group and 15 (10-25) min in the control group (p = 0.08). No delay was found on vs. 14 [9-21] min, p = 0.24). In contrast, there was an 8-min delay for MRI (30 [21.8-50] vs. 22 [14-30] min, p = 0.01). The median door-to-picture time was 29 min longer in patients treated with NPER than in those treated with nER, although the difference was not significant due to the small number of patients (47 [27-57] vs. 18 [11-26] min, p = 0.07). Conclusion:Our protocol could optimize the use of medical resources with only a 3-min delay in the door-to-picture time in an area without explosive outbreak. Unfortunately, the effectiveness of the protocol in preventing infection could not be verified because of the low incidence of COVID-19. When developing and modifying an institutional protocol, recognizing the outbreak status surrounding each institution is important.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Interpretation Of the 3-min Delay In The Door-topicture Timementioning

confidence: 99%

Section: Interpretation Of the 3-min Delay In The Door-topicture Timementioning

confidence: 99%

mentioning

confidence: 99%

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Initial Management of Patients with Suspected Stroke in the SARS-CoV-2 Era: Effects on the Door-to-Picture Time

Yoshimura

Yamaoka

Ishikawa

et al. 2021

JNET

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A un año de la pandemia en Argentina, características clínicas de pacientes con accidente cerebral agudo en una cohorte hospitalaria y sus implicancias

Gonzalez

Zambrano

Bala

et al. 2022

Neurología Argentina

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Analysis of onset-to-door time and its influencing factors in Chinese patients with acute ischemic stroke during the 2020 COVID-19 epidemic: a preliminary, prospective, multicenter study

Liao,

Qi,

et al. 2024

BMC Health Serv Res

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Background Pre-hospital delay in China is a serious issue with unclear relevant reasons, seriously impeding the adoption of appropriate measures. Herein, we analyzed the onset-to-door time (ODT) in Chinese patients with acute ischemic stroke (AIS) and its influencing factors. Methods We prospectively recruited 3,459 patients with AIS from nine representative tertiary general hospitals in China between January and June 2022. Patients were divided into ODT ≤ 3 h and ODT > 3 h groups. Following single-factor analysis, binary logistic regression analysis was performed to evaluate the risk factors leading to pre-hospital delay. Results In total, 763 (21.83%) patients arrived at the hospital within 3 h of onset. After adjusting for confounding factors, the risk factors for ODT were residence in rural areas (odds ratio [OR]: 1.478, 95% credibility interval [CI]: 1.024–2.146) and hospital transfer (OR: 7.479, 95% CI: 2.548–32.337). The protective factors for ODT were location of onset ≤ 20 km from the first-visit hospital (OR: 0.355, 95% CI: 0.236–0.530), transportation by emergency medical services (OR: 0.346, 95% CI: 0.216–0.555), history of atrial fibrillation (OR: 0.375, 95% CI: 0.207–0.679), moderate stroke (OR: 0.644, 95% CI: 0.462–0.901), and severe stroke (OR: 0.506, 95% CI: 0.285–0.908). Conclusions Most patients with AIS fail to reach a hospital within the critical 3-h window. The following measures are recommended to reduce pre-hospital delays: reasonable distribution of hospitals accessible to nearby residents, minimizing interhospital transfer, paying attention to patients with mild stroke, and encouraging patients to use ambulance services. Pre-hospital delays for patients can be reduced by implementing these measures, ultimately improving the timeliness of treatment and enhancing patient prognosis. This study was carried out amid the COVID-19 pandemic, which presented challenges and constraints.

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Modification of Acute Stroke Pathway in Korea After the Coronavirus Disease 2019 Outbreak

Cited by 5 publications

References 23 publications

Initial Management of Patients with Suspected Stroke in the SARS-CoV-2 Era: Effects on the Door-to-Picture Time

Initial Management of Patients with Suspected Stroke in the SARS-CoV-2 Era: Effects on the Door-to-Picture Time

A un año de la pandemia en Argentina, características clínicas de pacientes con accidente cerebral agudo en una cohorte hospitalaria y sus implicancias

Analysis of onset-to-door time and its influencing factors in Chinese patients with acute ischemic stroke during the 2020 COVID-19 epidemic: a preliminary, prospective, multicenter study

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