Stroke management during the coronavirus disease 2019 (COVID-19) pandemic: experience from three regions of the north east of Italy (Veneto, Friuli-Venezia-Giulia, Trentino-Alto-Adige)

Abstract

Background Efficiency of care chain response and hospital reactivity were and are challenged for stroke acute care management during the pandemic period of coronavirus disease 2019 (COVID-19) in North-Eastern Italy (Veneto, Friuli-Venezia-Giulia, Trentino-Alto-Adige), counting 7,193,880 inhabitants (ISTAT), with consequences in acute treatment for patients with ischemic stroke. Methods We conducted a retrospective data collection of patients admitted to stroke units eventually treated with thrombolysis and thrombectomy, ranging from January to May 2020 from the beginning to the end of the main first pandemic period of COVID-19 in Italy. The primary endpoint was the number of patients arriving to these stroke units, and secondary endpoints were the number of thrombolysis and/or thrombectomy. Chi-square analysis was used on all patients; furthermore, patients were divided into two cohorts (pre-lockdown and lockdown periods) and the Kruskal-Wallis test was used to test differences on admission and reperfusive therapies. Results In total, 2536 patients were included in 22 centers. There was a significant decrease of admissions in April compared to January. Furthermore, we observed a significant decrease of thrombectomy during the lockdown period, while thrombolysis rate was unaffected in the same interval across all centers. Conclusions Our study confirmed a decrease in admission rate of stroke patients in a large area of northern Italy during the lockdown period, especially during the first dramatic phase. Overall, there was no decrease in thrombolysis rate, confirming an effect of emergency care system for stroke patients. Instead, the significant decrease in thrombectomy rate during lockdown addresses some considerations of local and regional stroke networks during COVID-19 pandemic evolution.

Impact of the COVID-19 Pandemic in the Acute Stroke Admissions and Outcomes in a Philippine Tertiary Hospital

“…A significantly higher proportion of patients with atrial fibrillation during the pandemic (19%, p value = 0.000) was observed in this study which was similarly reported in other countries [7, 10, 13]. While these risk factors for stroke would have significant effect in stroke severity and TOAST classification of patients, it is of note that similar to other studies there is significantly lower proportion of TIA cases during the pandemic [3, 7, 9, 10, 13]. As this study was not able to evaluate patients who did not seek hospital consultation, it is possible that the lower proportion of TIAs could be due to reluctance to seek hospital consultation for minor stroke symptoms.…”

“…The proportion of thrombolysis and endovascular treatment was significantly affected with even higher number of endovascular treatments done during the pandemic reflective of the higher proportion of cases of large vessel atherosclerosis. A higher rate of thrombolysis during pandemic among ischemic stroke patients was similarly observed by Bhatia et al [20] in India while other studies in Asian and European countries reported opposite results [3, 6, 12, 16, 17]. Despite this, the discharge outcome of ischemic stroke patients is still poor during the pandemic with more ischemic stroke patients dying than pre-pandemic.…”

“…Other countries that have been affected by COVID-19 underwent substantial changes in their own acute stroke management pathway. Multidisciplinary approaches triaging an allocation of COVID-19-dedicated areas are certain changes that have been in place in other countries [ 2 , 3 ]. Beds dedicated to stroke care have been transformed into COVID-19-dedicated intensive care units to cater the influx of severe COVID-19 patients [ 4 ].…”

“…Beds dedicated to stroke care have been transformed into COVID-19-dedicated intensive care units to cater the influx of severe COVID-19 patients [ 4 ]. As the public shifts their attention to COVID-19, many institutions have reported a decreased number of stroke admissions and decreased emergency room consultation for stroke [ 1 , 3 , 5 , 6 ]. Along with these are noted delayed reporting of stroke symptoms and longer last known-well time to consult time [ 6 , 7 , 8 , 9 , 10 ].…”

Enteral Nutrition and Hydration in Patients with Acute Stroke: Efficacy of an Automatic Pump System for Water Administration and Flushes—A Pilot Study

“…Nevertheless, the participants were selected with well-defined inclusion and exclusion criteria to be as homogenous as possible to reduce the factors that might have influenced the results. In addition to this, the study was performed during the COVID-19 pandemic, which resulted in a reorganization of the health services and admissions to the different units [ 36 ]. Some other measures might have been taken to assess long-term health outcomes (such as the length of stay, enteral nutrition duration or health status at 3–6 months); however, due to the pandemic, such factors might have been affected by the health service reorganization (e.g., follow-up visits were sometimes not performed or performed in a short phone interview).…”