Telestroke in the Time of COVID-19: The Mayo Clinic Experience

Huang, Josephine F.; Greenway, Melanie R.F.; Nasr, Deena M.; Chukwudelunzu, Felix E.; Demaerschalk, Bart M.; O’Carroll, Cumara B; Nord, Charisse A.; Pahl, Emily; Barrett, Kevin M.; Williams, Lindsy N.

doi:10.1016/j.mayocp.2020.06.007

Cited by 34 publications

(41 citation statements)

References 7 publications

(8 reference statements)

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“…We observed a decrease by nearly one quarter in the number of patients admitted to our primary stroke center with stroke or TIA from a mean-rate of 95.9 (±6.3) per month between January 2019 and February 2020 to 74 (±12.7) in March/April 2020. Our observation is in line with numerous reports of decreased stroke rates during the pandemic from North America ( 4 , 9 , 10 ), Canada ( 5 ), and Brazil ( 6 ). In addition, a decrease in the usage of the RAPID-software, a tool used to assess infarct volume in case of acute stroke symptoms, was observed by mid-March 2020 ( 11 ) and telestroke services were less frequently used ( 9 ).…”

Section: Discussionsupporting

confidence: 93%

“…Our observation is in line with numerous reports of decreased stroke rates during the pandemic from North America ( 4 , 9 , 10 ), Canada ( 5 ), and Brazil ( 6 ). In addition, a decrease in the usage of the RAPID-software, a tool used to assess infarct volume in case of acute stroke symptoms, was observed by mid-March 2020 ( 11 ) and telestroke services were less frequently used ( 9 ). Similar observations of reduced hospital admissions and patient presentations at emergency departments are reported in other diseases such as myocardial infarction ( 12 , 13 ).…”

Section: Discussionsupporting

confidence: 93%

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Stroke Care Within the COVID-19 Pandemic—Increasing Awareness of Transient and Mild Stroke Symptoms Needed

et al. 2020

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Background: The COVID-19 pandemic might affect health care resources and alter patient admission to hospital in case of stroke or transient ischemic attack (TIA). We aim to determine whether the COVID-19 pandemic is affecting utilization of recanalization procedures and numbers of patients with stroke and TIA admitted to a primary care stroke center. Methods: In this retrospective observational study, we compared patients admitted from January 2019 until February 2020 with patients admitted during the COVID-19 pandemic (March/April 2020) in Germany. We included patients with stroke (hemorrhagic or ischemic) or TIA as classified by International Statistical Classification of Diseases and Related Health Problems version 10 (ICD-10). Results: The number of patients per month with ischemic stroke or TIA was found to have significantly decreased from January 2019 until February 2020 compared to the COVID-19 pandemic (March/April 2020) (ischemic stroke 69.1 ± 4.5 vs. 55 ± 5.7, p < 0.001, TIA 22.1 ± 4.1 vs. 14.5 ± 6.4, p < 0.034). Contrarily, percentages and numbers of recanalization procedures per month were not influenced by the COVID-19 pandemic (intravenous thrombolysis [iv-tPA] 9.4 ± 3.7 vs. 10.5 ± 0.5, p = 0.697, mechanical thrombectomy [MT] 13.1 ± 3.1 vs. 14.5 ± 3.5, p = 0.580, iv-TPA or MT 19.4 ± 4.1 vs. 19.0 ± 0.0, p = 0.889). Conclusions: During the COVID-19 pandemic, resources of the healthcare system in a primary care university hospital in Germany still allowed for unchanged numbers of recanalization procedures due to ischemic stroke. However, the numbers of patients admitted to the hospital specifically due to ischemic stroke or TIA decreased, suggesting that the awareness for non-disabling stroke symptoms has to be increased.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Stroke Care Within the COVID-19 Pandemic—Increasing Awareness of Transient and Mild Stroke Symptoms Needed

et al. 2020

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“…During the pandemic, one major negative impact on acute care for stroke was the decline in emergency hospital admissions, consistent with reports in different regions in China or other countries. The degree of reduction varied from 10 to 70% (11,13,13,(16)(17)(18)(19)(26)(27)(28)(29)(30)(31). One recent report in China also reported a 40% reduction in stroke hospital admissions (16), similar to our results (45.6%).…”

Section: Discussionsupporting

confidence: 89%

Reductions in Hospital Admissions and Delays in Acute Stroke Care During the Pandemic of COVID-19

Chen

Wang

et al. 2020

Front. Neurol.

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Background: Rapid and effective medical care for stroke is paramount to achieve maximal functional recovery. Because of the wide spreading of the coronavirus disease in 2019 (COVID-19), acute stroke care is negatively impacted. How much acute care for stroke has been affected during the pandemic remains to be assessed. Methods: The first-level response to major public health was launched from January 24th to April 29th, 2020 in Beijing to contain the spread of COVID-19. Based on a database connecting all 77 stroke centers, the quantity and quality in emergency care for stroke during the 97 lockdown days were compared with the equivalent period in 2019. During the pandemic, 15 of the 77 stroke centers were designated to receive patients sick with COVID-19. Subgroup analyses were carried out by different types of hospitals (designated and undesignated). Results: There were 1,281 and 2,354 stroke emergency hospital admissions in the lockdown period and the parallel period in 2019, respectively. A reduction of 45.6% in admission was shown in the lockdown period, with more reductions for hemorrhagic stroke (69.0%) compared with ischemic stroke (42.9%). More reductions happened in COVID-19 designated hospitals (52.6%) compared with undesignated hospitals (41.8%). The mean NIHSS score at hospital arrival was significantly higher in the lockdown period (9.4 ± 7.7 in 2020 vs. 8.4 ± 7.8 in 2019, P < 0.001). For the metrics measuring the quality of acute stroke care, the onset to door (OTD), onset to needle (ONT), and onset to recanalization (OTR) times didn't change significantly, while significant delays are shown for the door to CT scan (DTC, 1 min delay), door to needle (DTN, 4 min delays), and door to puncture (DTP, 29 min delays) times, which mainly happened in COVID-19 undesignated hospitals. Conclusions: Profound reductions in stroke hospital admissions and significant delays in emergency care for acute ischemic stroke occurred during the pandemic of COVID-19. Engagement and effective communication with all stakeholders including patients, health care providers, governmental policymakers, and other implementation partners are required for future success in similar crises.

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“…Another problem may have been that awareness of stroke warning signs and symptoms among our emergency department colleagues who should activate the stroke code or call neurologists may be suboptimal due to excessive replacement of frontline staff or a preferential effort to prioritize pandemic care [ 22 ]. This could also have been the case in the emergency departments of the smaller hospitals in the network and would further explain why stroke activity was dramatically reduced [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Slump in Hospital Admissions for Stroke, a Fact of an Uncertain Nature That Requires Explanation

Ramírez-Moreno

Portilla-Cuenca

Hariramani-Ramchandani

et al. 2021

Brain Sciences

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(1) Background: The impact of the health crisis caused by coronavirus disease 2019 (COVID-19) has provoked collateral effects in the attention to pathologies with time-dependent treatments such as strokes. We compare the healthcare activity of two stroke units in the same periods of 2019 and 2020, with an emphasis on what happened during the state of alarm (SA). (2) Materials and methods. Hospitals in the region implemented contingency plans to contain the pandemic; in this planning, the stroke units were not limited in their operational capacity. The SA was declared on 15 March and remained in place for 10 weeks. For the analysis, the data were grouped by consecutive calendar weeks. (3) Results. When the SA was declared the number of calls to the emergency telephone went from 1225 to 3908 calls per week (318% increase). However, the activation of the stroke code went from 6.6 to 5.0 (p = 0.04) and the activity in both stroke units decreased. The largest drop in hospitalizations was for transient ischemic attacks (TIAs) with 35.7% less, 28 vs. 18, (p = 0.05). Reperfusion therapies fell by 37.5%; Poisson regression model 0.64; (95% confidence interval (CI), 0.43–0.95). The overall activity of the telestroke suffered a reduction of 28.9%. We also observed an increase in hospital mortality. (4) Conclusion. The excessive duration of the pandemic precludes any hope of resolving this public health crisis in the short or medium term. Further studies should be conducted to better understand the multifactorial nature of this dramatic decline in stroke admissions and its negative impact.

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Telestroke in the Time of COVID-19: The Mayo Clinic Experience

Cited by 34 publications

References 7 publications

Stroke Care Within the COVID-19 Pandemic—Increasing Awareness of Transient and Mild Stroke Symptoms Needed

Stroke Care Within the COVID-19 Pandemic—Increasing Awareness of Transient and Mild Stroke Symptoms Needed

Reductions in Hospital Admissions and Delays in Acute Stroke Care During the Pandemic of COVID-19

Slump in Hospital Admissions for Stroke, a Fact of an Uncertain Nature That Requires Explanation

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