The effect of the COVID-19 pandemic on ED referrals and care for stroke patients: A four-year comparative study

Saban, Mor; Reznik, Anna; Shachar, Tal; Wilf‐Miron, Rachel; Sivan-Hoffmann, Rotem

doi:10.1016/j.jcrc.2020.12.011

Cited by 14 publications

(14 citation statements)

References 20 publications

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“…Our results align with recent reports emphasizing the effects of the COVID-19 pandemic on stroke management. Saban et al found an increase in the proportion of patients with acute ischemic stroke who arrived shortly after the onset of symptoms and received timely treatment [18] . Furthermore, in the home quarantine period, we didn’t observe any significant delay to reperfusion for IVT and MT in door-to-needle and door-to-puncture time, respectively.…”

Section: Discussionmentioning

confidence: 99%

The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19

Haki

Deniz²

2022

Clinical Neurology and Neurosurgery

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Section: Discussionmentioning

confidence: 99%

The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19

Haki

Deniz²

2022

Clinical Neurology and Neurosurgery

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“…Some studies reported a decrease in the number of in-hospital cardiac and cerebral events during the pandemic [ 17 , 18 ]. In our study, we examined the behavior of patients and the MOH for 10 months and over three lockdowns.…”

Section: Discussionmentioning

confidence: 99%

High Non-COVID-19 in-Hospital Deaths during the First Lockdown in Israel Compared with the Second and Third Lockdowns

Bord

Tur‐Sinai

Basis

2022

IJERPH

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During the first lockdown in Israel, citizens were instructed to visit community clinics only for urgent cases. However, they were not informed that emergency departments (EDs) were safe. Reports from the National Ambulance Services showed a 22% increase in at-home deaths during the lockdown. Perhaps, the reason is because some critically ill patients postponed referrals and came “at the last minute”. After the first lockdown, the Ministry of Health (MOH) declared that hospital EDs were safe. The objective of the study was to examine the rates of admission from EDs to hospital wards, and non-COVID-19 in-hospital deaths during the first lockdown in Israel, compared with the second and third lockdowns. From the business intelligence software of the Rambam Medical Center in Israel, we collected data about the rates of admission to the ED, the non-COVID-19 in-hospital deaths during the three lockdowns, during the same periods in the previous three years, and the main five causes of non-COVID-19 deaths. Data comparison was done using multiple chi-square tests. ED admission numbers were significantly higher during the first lockdown than during the second (χ2 (1, n = 36,245) = 24.774, p = 0.00001) and third lockdowns (χ2 (1, n = 36,547) = 8.7808, p = 0.0030). We found a significantly higher number of non-COVID-19 in-hospital deaths vs. discharges during the first lockdown than in the second and third lockdowns (χ2 (2, n = 26,268) = 7.794, p = 0.0203) The number of deaths due to respiratory diseases was significantly higher during the first lockdown than in the second lockdown (χ2 (1, n = 572) = 8.8185, p = 0.0029) and in the third lockdown (χ2 (1, n = 624) = 9.0381, p = 0.0026), and deaths from infectious diseases were higher during the first lockdown than during both the second and third lockdowns (χ2 (1, n = 566) = 5.9479, p = 0.0147, and χ2 (1, n = 624) = 9.5978, p = 0.0019), respectively. The onset of CVA and CVD are abrupt, while respiratory and infectious diseases may have an insidious pattern; this may have led patients to postpone referrals to hospitals to the “last minute” during the first lockdown, perhaps due to fears of contracting COVID-19, and as a result of vague instructions. Citizens and policymakers must be made aware of this point during future pandemics.

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“…COVID-19 has critically stressed the global healthcare systems, which not only has affected virally infected patients, but has also generated collateral damage on acute time-dependent conditions, particularly cerebrovascular and cardiovascular diseases. There has been a significant reduction in the number of stroke admissions [148][149][150][151], due to a shrinking of the primary prevention system, cancellations of follow-up visits for secondary prevention, and also the need for a reorganization of the emergency system. Some European countries have reorganized their centralization of acute stroke treatment to a limited number of hospitals, and stroke unit beds have been, in part, readapted into intermediate or intensive care beds for COVID-19 patients, with multidisciplinary management being limited [152].…”

Section: Stroke During Covid-19 Pandemicmentioning

confidence: 99%

Treatments in Ischemic Stroke: Current and Future

Mosconi¹,

Paciaroni²

2022

Eur Neurol

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Background and Aim: Despite progress made over the last 30 years, stroke is still a leading cause of disability and mortality; likewise, its burden is expected to increase over the next decades, due to population growth and aging. The development of drugs with better safety-efficacy profiles as well as strategies able to improve ischemic stroke management from the pre-hospital setting is needed. Summary: The pathophysiology of ischemic stroke involves multiple pathways resulting in cerebral artery obstruction and brain tissue ischemia. To date, the only approved drug for acute ischemic stroke is intravenous thrombolytic alteplase. Intravenous thrombolysis (IVT) can be administered alone or in combination with endovascular treatment (EVT) with mechanical thrombectomy, in case of large vessel occlusion and generally within 6 h from symptoms onset. The risk of potential bleeding complications, especially symptomatic intracerebral hemorrhage, is one of the reasons for the reluctance to administer IVT. Tenecteplase is a promising alternative fibrinolytic agent, having a better safety profile than alteplase. Moreover, recent evidences have allowed an extension of the IVT ± EVT time window for patients with unknown onset time and for those with a known onset time thanks to the new “tissue-window” approach guided by advanced neuroimaging techniques, which also helps in collateral circulation estimation. Regarding primary-secondary prevention, researchers are focused on improving the efficacy of antithrombotic drugs with a “hemostasis-sparing” approach. Neuroprotective agents are also under development, particularly stem cells. The COVID-19 pandemic has critically stressed global healthcare systems, with collateral damage resulting in access delivery of only emergency care, such as ischemic stroke. Regarding telemedicine, it has had a minor role in acute stroke management, and with the onset of COVID-19, this role will most likely be adopted to increase access and delivery in stroke assessment, but also in the follow-up.

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The effect of the COVID-19 pandemic on ED referrals and care for stroke patients: A four-year comparative study

Cited by 14 publications

References 20 publications

The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19

The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19

High Non-COVID-19 in-Hospital Deaths during the First Lockdown in Israel Compared with the Second and Third Lockdowns

Treatments in Ischemic Stroke: Current and Future

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