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Journal Articles Stroke Year : 2021

Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown

Valerian Altersberger
  • Function : Author
Lotte Stolze
  • Function : Author
Mirjam Heldner
Hilde Henon
  • Function : Author
Nicolas Martinez-Majander
  • Function : Author
Christian Hametner
  • Function : Author
Annika Nordanstig
  • Function : Author
Andrea Zini
Stefania Nannoni
Christian Nolte
  • Function : Author
Philipp Baumgartner
  • Function : Author
Andreas Kastrup
  • Function : Author
Panagiotis Papanagiotou
  • Function : Author
Georg Kägi
  • Function : Author
Ronen Leker
  • Function : Author
Marialuisa Zedde
  • Function : Author
Alessandro Padovani
  • Function : Author
Alessandro Pezzini
  • Function : Author
Visnja Padjen
  • Function : Author
Carlo Cereda
  • Function : Author
Georges Ntaios
  • Function : Author
Leo Bonati
  • Function : Author
Leon Rinkel
  • Function : Author
Urs Fischer
Jan Scheitz
  • Function : Author
Susanne Wegener
  • Function : Author
Guillaume Turc
Patrik Michel
  • Function : Author
Mauro Gentile
  • Function : Author
Alexandros Rentzos
  • Function : Author
Peter Ringleb
  • Function : Author
Sami Curtze
  • Function : Author
Charlotte Cordonnier
  • Function : Author
Marcel Arnold
  • Function : Author
Paul Nederkoorn
  • Function : Author
Stefan Engelter
  • Function : Author
Henrik Gensicke
  • Function : Author

Abstract

Background and Purpose: Timely reperfusion is an important goal in treatment of eligible patients with acute ischemic stroke. However, during the coronavirus disease 2019 (COVID-19) pandemic, prehospital and in-hospital emergency procedures faced unprecedented challenges, which might have caused a decline in the number of acute reperfusion therapy applied and led to a worsening of key quality measures for this treatment during lockdown. Methods: This prospective multicenter cohort study used data from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry of patients with acute ischemic stroke treated with reperfusion therapies, that is, intravenous thrombolysis or endovascular therapy. We compared prehospital and in-hospital time-based performance measures (stroke-onset-to-admission, admission-to-treatment, admission-to-image, and image-to-treatment time) during the first 6 weeks after announcement of lockdown (lockdown period) with the same period in 2019 (reference period). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale) after 24 hours and occurrence of symptomatic intracranial hemorrhage (following the ECASS [European-Australasian Acute Stroke Study]-II criteria). Results: Across 20 stroke centers, 540 patients were treated with intravenous thrombolysis/endovascular therapy during lockdown period compared with 578 patients during reference period (−7% [95% CI, 5%–9%]). Performance measures did not change significantly during the lockdown period (2020/2019 minutes median: onset-to-admission 133/145; admission-to-treatment 51/48). Same was true for admission-to-image (20/19) and image-to-treatment (31/30) time in patients with available time of first image (n=871, 77.9%). Median National Institutes of Health Stroke Scale on admission (2020/2019: 11/11) and after 24 hours (2020/2019: 6/5) and percentage of symptomatic intracranial hemorrhage (2020/2019: 6.2/5.7) did not differ significantly between both periods. Conclusions: The COVID-19 pandemic lockdown resulted in a mild decline in the number of patients with stroke treated with acute reperfusion therapies. More importantly, the solid stability of key quality performance measures between the 2020 and 2019 period may indicate resilience of acute stroke care service during the lockdown, at least in well-established European stroke centers.

Dates and versions

hal-03238557 , version 1 (27-05-2021)

Identifiers

Cite

Valerian Altersberger, Lotte Stolze, Mirjam Heldner, Hilde Henon, Nicolas Martinez-Majander, et al.. Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown. Stroke, 2021, 52 (5), pp.1693-1701. ⟨10.1161/STROKEAHA.120.032176⟩. ⟨hal-03238557⟩

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