1
|
Bottega F, Kacerik E, Perotti G, Signorelli C, Ristagno G. Reshaping Emergency Care: Dynamics of OHCA and STEMI in a Three-Year Analysis. EPIDEMIOLOGIA 2024; 5:362-370. [PMID: 39051206 PMCID: PMC11270370 DOI: 10.3390/epidemiologia5030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/02/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
The COVID-19 pandemic drastically reshaped healthcare in Lombardy, Italy, notably impacting EMS and emergency departments and altering the epidemiology of time-dependent pathologies such as STEMI and OHCA. While previous studies focused on modifications during the pandemic peak, with an increase in the number of OHCA diagnoses and a reduction in the number of STEMI, little evidence exists regarding the inter-pandemic phases. We analyzed OHCA and STEMI accesses to the ED in the regional emergency department access register (EUOL) for 2019-2021. The analysis revealed a significant difference in monthly diagnosis averages. For STEMI, the change was statistically significant (F(2, 33) = 4.45, p = 0.02), while it was not for OHCA (F(2, 33) = 0.18, p = 0.83). Despite the monthly decreases, the likelihood of receiving a STEMI diagnosis increased with total accesses, OR 1.40 [95% CI 1.25-1.58, p < 0.0001]. Additionally, there was a significant increase in March 2020 discharge diagnoses for OHCA compared to March 2019, OR 3.35 [95% CI 2.88-3.90, p < 0.0001], corresponding to the first pandemic wave. Therefore, our analysis indicates that the epidemiology of STEMI and OHCA was altered during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Francesca Bottega
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Erika Kacerik
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Gabriele Perotti
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20124 Milano, Italy
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Giuseppe Ristagno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Via Festa del Perdono 7, 20122 Milano, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20090 Milano, Italy
| |
Collapse
|
2
|
Kacerik E, Bottega F, Andreassi A, Sechi G, Zoli A, Botteri M, Signorelli C, Fagoni N. Italy's Post-COVID-19 Stroke Network: Has It Returned to Pre-Pandemic Standards? EPIDEMIOLOGIA 2024; 5:353-361. [PMID: 39051205 PMCID: PMC11270169 DOI: 10.3390/epidemiologia5030025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/10/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
The COVID-19 pandemic strongly transformed the healthcare system in the Lombardy region (Italy), forcing a rapid reorganization of hospital structures. The emergency medical service (EMS) system and emergency departments (EDs) were among the most affected departments. Several studies have shown a change in the epidemiology of time-dependent pathologies, such as stroke, during the pandemic's peak. However, there is little scientific evidence regarding the interpandemic phase. The regional register for ED accesses (EUOL) was analyzed, taking into consideration all accesses for stroke and stroke-like syndromes during the years 2019, 2020, and 2021. The analysis shows a significant difference in the average number of diagnoses per month [2092 vs. 1815 vs. 2015, respectively (p < 0.05)] and an increase in the percentage of transports carried out by EMS vehicles to EDs [17% vs. 25% vs. 22%, respectively (p < 0.05)]. The length of stay (LOS) increased for both discharged patients (9.0 vs. 10.1 vs. 11.2 h, respectively; p < 0.005) and hospitalized patients (7.5 vs. 9.7 vs. 10.6 h, respectively; p < 0.005). During the COVID-19 pandemic, the overall number of stroke diagnoses decreased, while the percentage of patients transported to EDs by EMS vehicles increased. Furthermore, an increased processing time in EDs was highlighted.
Collapse
Affiliation(s)
- Erika Kacerik
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Francesca Bottega
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Aida Andreassi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20124 Milano, Italy
| | - Giuseppe Sechi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20124 Milano, Italy
| | - Alberto Zoli
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20124 Milano, Italy
| | - Marco Botteri
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20124 Milano, Italy
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Nazzareno Fagoni
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| |
Collapse
|
3
|
Fagoni N, Bellini L, Bonora R, Botteri M, Migliari M, Pagliosa A, Sechi GM, Signorelli C, Zoli A, Stirparo G. Changing the stroke network during pandemic scenarios does not affect the management of patients with a positive Cincinnati prehospital stroke scale. Neurol Sci 2024; 45:655-662. [PMID: 37672177 PMCID: PMC10791942 DOI: 10.1007/s10072-023-07046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Time plays a crucial role in the management of stroke, and changing the prehospital emergency network, altering the HUB and spoke relationship in pandemic scenarios, might have an impact on time to fibrinolysis or thrombectomy. The aim of this study was to evaluate the time-dependent stroke emergency network in Lombardy region (Italy) by comparing 2019 with 2020 and early 2021. Three parameters were investigated: (i) time of arrival of the first vehicle at the scene, (ii) overall duration of missions, and (iii) number of patients transported by emergency vehicles. METHODS Data analysis process conducted using the SAS-AREU portal (SAS Institute, USA). RESULTS The number of patients with a positive CPSS was similar among the different pandemic waves. Mission duration increased from a mean time (SD) of 52.9 (16.1) min in 2019 to 64.1 (19.7) in 2020 and 55.0 (16.8) in 2021. Time to first vehicle on scene increased to 15.7 (8.4) min in 2020 and 16.0 (7.0) in 2021 compared to 2019, 13.6 (7.2) (P < 0.05). The number of hospital with available stroke units decreased from 46 in 2019 to 10 during the first pandemic wave. CONCLUSIONS The pandemic forced changes in the clinical mission of many hospitals by reducing the number of stroke units. Despite this, the organization of the emergency system allowed to identify strategic hospitals and thus avoid excessive transport time. The result was an adequate time for fibrinolysis/thrombectomy, in agreement with the guidelines. Coordinated management in emergency situations makes it possible to maintain service quality standards, despite the unfavorable scenario.
Collapse
Affiliation(s)
- Nazzareno Fagoni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili Di Brescia, Brescia, Italy.
| | - Lorenzo Bellini
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
| | - Rodolfo Bonora
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Marco Botteri
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili Di Brescia, Brescia, Italy
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Maurizio Migliari
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Andrea Pagliosa
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Giuseppe Maria Sechi
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Zoli
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Giuseppe Stirparo
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| |
Collapse
|
4
|
Zedde M, Pascarella R. Stroke Is an Emergency, Even During a Pandemic. Chest 2023; 163:471-472. [PMID: 36894255 PMCID: PMC9989322 DOI: 10.1016/j.chest.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/12/2022] [Indexed: 03/09/2023] Open
Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Neuromotor Physiology and Rehalibilitation, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
5
|
Dos Reis FI, de Magalhães PSC, Diegoli H, Longo AL, Moro CHC, Safanelli JA, Nagel V, Lange MC, Zétola VF. Stroke profile and care during the COVID-19 pandemic: What changed and what did not? A prospective cohort from Joinville, Brazil. Front Neurol 2023; 14:1122875. [PMID: 36873444 PMCID: PMC9977808 DOI: 10.3389/fneur.2023.1122875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction The COVID-19 pandemic has wrought negative consequences concerning quality of care for stroke patients since its onset. Prospective population-based data about stroke care in the pandemic are limited. This study aims to investigate the impact of COVID-19 pandemic on stroke profile and care in Joinville, Brazil. Methods A prospective population-based cohort enrolled the first-ever cerebrovascular events in Joinville, Brazil, and a comparative analyzes was conducted between the first 12 months following COVID-19 restrictions (starting March 2020) and the 12 months just before. Patients with transient ischemic attack (TIA) or stroke had their profiles, incidences, subtypes, severity, access to reperfusion therapy, in-hospital stay, complementary investigation, and mortality compared. Results The profiles of TIA/stroke patients in both periods were similar, with no differences in gender, age, severity, or comorbidities. There was a reduction in incidence of TIA (32.8%; p = 0.003). In both periods, intravenous thrombolysis (IV) and mechanical thrombectomy (MT) rates and intervals from door to IV/MT were similar. Patients with cardioembolic stroke and atrial fibrillation had their in-hospital stay abbreviated. The etiologic investigation was similar before and during the pandemic, but there were increases in cranial tomographies (p = 0.02), transthoracic echocardiograms (p = 0.001), chest X-rays (p < 0.001) and transcranial Doppler ultrasounds (p < 0.001). The number of cranial magnetic resonance imaging decreased in the pandemic. In-hospital mortality did not change. Discussion The COVID-19 pandemic is associated with a reduction in TIA, without any influence on stroke profile, the quality of stroke care, in-hospital investigation or mortality. Our findings show an effective response by the local stroke care system and offer convincing evidence that interdisciplinary efforts are the ideal approach to avoiding the COVID-19 pandemic's negative effects, even with scarce resources.
Collapse
Affiliation(s)
| | | | - Henrique Diegoli
- Division of Neurology, Hospital Municipal São José, Joinville, Santa Catarina, Brazil
| | - Alexandre Luiz Longo
- Division of Neurology, Hospital Municipal São José, Joinville, Santa Catarina, Brazil
| | | | | | - Vivian Nagel
- Hospital Municipal São José, Joinville Stroke Registry, Joinville, Santa Catarina, Brazil
| | | | | |
Collapse
|
6
|
Stirparo G, Bellini L, Ristagno G, Bonora R, Pagliosa A, Migliari M, Andreassi A, Signorelli C, Sechi GM, Fagoni N. The Impact of COVID-19 on Lombardy Region ST-Elevation Myocardial Infarction Emergency Medical System Network-A Three-Year Study. J Clin Med 2022; 11:5718. [PMID: 36233584 PMCID: PMC9573454 DOI: 10.3390/jcm11195718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: The COVID-19 pandemic had a significant impact on emergency medical systems (EMS). Regarding the ST-elevation myocardial infarction (STEMI) dependent time network, however, there is little evidence linked to the post-pandemic phase regarding this issue. Such information could prove to be of pivotal importance regarding STEMI clinical management, especially pre-hospital clinical protocols such as fibrinolysis. Methods: A retrospective observational cohort study of all STEMI rescues recorded in the Lombardy EMS registry from the 1st of January 2019 to the 30th of December 2021. Results: Regarding the number of STEMI diagnoses, March 2020 (first pandemic wave in Italy) saw a reduction compared to March 2019 (OR 0.76 [0.60-0.93], p = 0.011). The average time of the entire mission increased to 63.1 min in 2021, reaching 64.7 min in 2020, compared with 57.7 min in 2019. The number of HUBs for STEMI patients saw a reduction, falling from 52 HUBs in the pre-pandemic phase to 13 HUBs during the first wave. Conclusions: During the pandemic phase, there was an increase in the transportation times of STEMI patients from home to the hospital. Such changes did not alter the clinical approach in the out-of-hospital phase. Indeed, the implementation of fibrinolysis was not required.
Collapse
Affiliation(s)
- Giuseppe Stirparo
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20090 Milano, Italy
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Lorenzo Bellini
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20090 Milano, Italy
| | - Giuseppe Ristagno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti Via Festa del Perdono 7, 20122 Milano, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20090 Milano, Italy
| | - Rodolfo Bonora
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Andrea Pagliosa
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Maurizio Migliari
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Aida Andreassi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20090 Milano, Italy
| | - Giuseppe M. Sechi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Nazzareno Fagoni
- Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Piazza del Mercato, 15, 25121 Brescia, Italy
| |
Collapse
|
7
|
Spina E, Candelaresi P, Volpe G, D'Onofrio F, Spitaleri D, Martusciello G, Piccirillo G, Briganti F, Muto M, Feleppa M, Sparaco M, Manto A, Cuomo T, Ascione S, Ripa P, Romano DG, Andreone V, Manganelli F, Napoletano R. Trends of recanalization therapies and state of art for ischemic stroke treatment in Campania region, Italy. Neurol Sci 2022; 43:6865-6870. [PMID: 36074192 PMCID: PMC9663370 DOI: 10.1007/s10072-022-06321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/31/2022] [Indexed: 12/02/2022]
Abstract
Background
According to the last Italian report by the Ministry of Health in 2018, the estimated number of acute ischemic strokes (AIS) in Campania is 10,000/year, with an expected number of 1390 intravenous thrombolysis (IVT) and 694 mechanical thrombectomies (MT). In 2017, only 1.5% of expected patients received IVT and 0.2% MT. This study analyzed the trend of IVT and MT in 2019–2020 and depicted the state of art of Stroke Care in Campania. Methods From the regional health task force, we obtained the hospital discharge forms from all private and public hospitals in Campania; we selected patients with a principal diagnosis of AIS and measured the rate of patients admitted to neurology units and the rate of IVT, MT, and IVT + MT for both 2019 and 2020. Results In 2019, we observed 4817 admissions for AIS; 2858/4817 (59.3%) patients were admitted to neurology units. Out of 4817 patients, 192 received IVT, 165 MT, and 131 IVT + MT (488 treated patients; 10.1%). In 2020, we observed 4129 admissions for AIS; 2502/4129 (62.7%) patients were admitted to neurology units. Out of 4129 patients, 198 received IVT, 250 MT, and 180 IVT + MT (628 treated patients; 15.2%). These results showed that despite a reduction of AIS admissions in 2020, the relative and absolute rate of recanalization treatments increased. However, the number of patients who were not admitted to neurology units nor received acute treatments remained dramatically high. Conclusion Despite the development of acute treatments, the Campania Stroke Network still needs significative efforts to improve.
Collapse
Affiliation(s)
- Emanuele Spina
- Department of Neurosciences, Reproductive and Odontostomatology, University of Naples "Federico II", Via Pansini, 5, Naples, Italy.
- Neurology Unit, P.O. "San Leonardo", Castellammare Di Stabia, Italy.
| | | | - Giampiero Volpe
- Neurology and Stroke Unit, AOU "San Giovanni Di Dio Ruggi d'Aragona", Salerno, Italy
| | | | - Daniele Spitaleri
- Neurology and Stroke Unit, AORN "San Giuseppe Moscati", Avellino, Italy
| | | | - Giovanni Piccirillo
- Neurology and Stroke Unit, AORN "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Francesco Briganti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mario Muto
- Diagnostic and Interventional Neuroradiology, AORN Antonio Cardarelli, Naples, Italy
| | | | - Marco Sparaco
- Neurology and Stroke Unit, AORN "San Pio", Benevento, Italy
| | - Andrea Manto
- Neuroradiology Unit, P.O. "Umberto I", Nocera Inferiore, Italy
| | - Teresa Cuomo
- Neurology and Stroke Unit, P.O. "Umberto I", Nocera Inferiore, Italy
| | | | - Patrizia Ripa
- Neurology and Stroke Unit, P.O. "Ospedale del Mare", Naples, Italy
| | - Daniele Giuseppe Romano
- Department of Diagnostic and Interventional Neuroradiology, University Hospital "San Giovanni Di Dio E Ruggi d'Aragona", Salerno, Italy
| | | | - Fiore Manganelli
- Department of Neurosciences, Reproductive and Odontostomatology, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Rosa Napoletano
- Neurology and Stroke Unit, AOU "San Giovanni Di Dio Ruggi d'Aragona", Salerno, Italy
| |
Collapse
|
8
|
Improta G, Borrelli A, Triassi M. Machine Learning and Lean Six Sigma to Assess How COVID-19 Has Changed the Patient Management of the Complex Operative Unit of Neurology and Stroke Unit: A Single Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095215. [PMID: 35564627 PMCID: PMC9103695 DOI: 10.3390/ijerph19095215] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 02/04/2023]
Abstract
Background: In health, it is important to promote the effectiveness, efficiency and adequacy of the services provided; these concepts become even more important in the era of the COVID-19 pandemic, where efforts to manage the disease have absorbed all hospital resources. The COVID-19 emergency led to a profound restructuring—in a very short time—of the Italian hospital system. Some factors that impose higher costs on hospitals are inappropriate hospitalization and length of stay (LOS). The length of stay (LOS) is a very useful parameter for the management of services within the hospital and is an index evaluated for the management of costs. Methods: This study analyzed how COVID-19 changed the activity of the Complex Operative Unit (COU) of the Neurology and Stroke Unit of the San Giovanni di Dio e Ruggi d’Aragona University Hospital of Salerno (Italy). The methodology used in this study was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC roadmap, characterized by five operational phases. To add even more value to the processing, a single clinical case, represented by stroke patients, was investigated to verify the specific impact of the pandemic. Results: The results obtained show a reduction in LOS for stroke patients and an increase in the value of the diagnosis related group relative weight. Conclusions: This work has shown how, thanks to the implementation of protocols for the management of the COU of the Neurology and Stroke Unit, the work of doctors has improved, and this is evident from the values of the parameters taken into consideration.
Collapse
Affiliation(s)
- Giovanni Improta
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy;
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80131 Naples, Italy
- Correspondence:
| | - Anna Borrelli
- “San Giovanni di Dio e Ruggi d’Aragona” University Hospital, 84121 Salerno, Italy;
| | - Maria Triassi
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy;
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80131 Naples, Italy
| |
Collapse
|
9
|
Drenck N, Grundtvig J, Christensen T, Iversen HK, Kruuse C, Truelsen T, Wienecke T, Christensen H. Stroke admissions and revascularization treatments in Denmark during COVID-19. Acta Neurol Scand 2022; 145:160-170. [PMID: 34605006 PMCID: PMC8653351 DOI: 10.1111/ane.13535] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 01/01/2023]
Abstract
Objective The aim of this study was to assess the number of stroke‐related admissions and acute treatments during the first two waves of COVID‐19 and lockdowns in the Capital Region of Denmark and the Region of Zealand. Materials & Methods The weekly numbers of admitted patients with stroke were retrieved from electronic patient records from January 2019 to February 2021 and analysed to reveal potential fluctuations in patient volumes during the pandemic. Results A total of 23,688 patients were included, of whom 2049 patients were treated with tissue‐type plasminogen activators (tPA) and 552 underwent endovascular thrombectomy (EVT). We found a transient decrease in the number of weekly admitted patients (pts/week) with all strokes (−9.8 pts/week, 95% CI: −19.4; −0.2, p = .046) and stroke mimics (−30.1 pts/week, 95% CI: −39.9; −20.3, p < .001) during the first lockdown compared to pre‐COVID‐19. The number of subarachnoid haemorrhage, intracerebral haemorrhage, and ischaemic stroke admissions showed insignificant declines. Analysing all COVID‐19 periods collectively revealed increased volumes of ischaemic stroke (+6.2 pts/week, 95% CI: +1.6; +10.7, p = .009) compared to pre‐COVID levels, while numbers of stroke mimics remained lower than pre‐COVID. Weekly tPA and EVT treatments remained constant throughout the study period. Conclusions Our results are comparable with other studies in finding reductions in stroke‐related admissions early in the pandemic. This is the first study to report increased stroke volumes following the first wave of the pandemic. The mechanisms behind the observed drop and subsequent rise in strokes are unclear and warrant further investigation.
Collapse
Affiliation(s)
- Nicolas Drenck
- Department of Neurology Copenhagen University Hospital–Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Josefine Grundtvig
- Department of Neurology Copenhagen University Hospital–Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Thomas Christensen
- Department of Neurology Copenhagen University Hospital–Nordsjællands Hospital Hillerød Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Helle Klingenberg Iversen
- Department of Neurology Copenhagen University Hospital–Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Christina Kruuse
- Department of Neurology Copenhagen University Hospital–Herlev Gentofte Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Thomas Truelsen
- Department of Neurology Copenhagen University Hospital–Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Troels Wienecke
- Department of Neurology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Hanne Christensen
- Department of Neurology Copenhagen University Hospital–Bispebjerg and Frederiksberg Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| |
Collapse
|
10
|
Corea F, Acciarresi M, Bernetti L, Brustenghi P, Guidubaldi A, Maiotti M, Micheli S, Pierini V, Gamboni A, Calabrò G, Busti C, Magistrato C, Proietti-Silvestri G, Bracaccia M, Caso V, Zampolini M. Extending Thrombolysis in Acute Ischemic Stroke to Primary Care: Early Experiences with a Network-Based Teleneurology Approach. Neurol Int 2022; 14:164-173. [PMID: 35225883 PMCID: PMC8884013 DOI: 10.3390/neurolint14010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
Background and Purpose—Systemic thrombolysis represents the main proven therapy for acute ischemic stroke, but safe treatment is reported only in well-established stroke units. To extend the use of tissue plasminogen activator (tPA) treatment in primary care hospitals on isolated areas through telemedic was the purpose of specific initiatives in southern Umbria, Italy. Methods—The stroke center of Foligno established a telestroke network to provide consultations for three local hospitals in southern Umbria. The telemedic system consists of a digital network that includes a two-way video conference system and imaging sharing. The main network hospital established specialized stroke wards/teams in which qualified teams treat acute stroke patients. Physicians in these hospitals are able to contact the stroke centers 24 h per day. Quality data are available to support the safe implementation of the stroke procedures. Those available from governmental authorities and local datasets are volume of hospitalization, in-hospital mortality, 30-days mortality, and discharge setting. Objective of the study was to assess the annual hospitalization volume in both the hub and spoke hospitals for ischemic stroke and appraise the performance of the network after the introduction of the telestroke system. Results—A total of 225 systemic thrombolyses were performed in time period indicated above all hospitals. In the main spoke hospital, 41 procedures were performed after teleconsultations were made available. The thrombolysis rate in the hub hospital ranged between 10% in 2016 and 20% in 2019, while in the spoke hospital was below 5% in 2016 and raised to 15% in 2019. The statistically significant difference, in the number of procedures, between hub and spoke in the beginning of the observation time disappeared after introduction of the telestroke network. No increase of the mortality was found. Conclusions—The present data suggest that systemic thrombolysis indicated via stroke experts in the setting of teleconsultation shows similar complication rates to those reported in the National Institute of Neurological Disorders and Stroke trial. Therefore, tPA treatment is also safe in this context and can be extended to primary hospitals.
Collapse
Affiliation(s)
- Francesco Corea
- Stroke Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy; (M.A.); (L.B.); (P.B.); (A.G.); (M.M.); (S.M.); (V.P.); (M.Z.)
- Correspondence:
| | - Monica Acciarresi
- Stroke Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy; (M.A.); (L.B.); (P.B.); (A.G.); (M.M.); (S.M.); (V.P.); (M.Z.)
| | - Laura Bernetti
- Stroke Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy; (M.A.); (L.B.); (P.B.); (A.G.); (M.M.); (S.M.); (V.P.); (M.Z.)
| | - Pierluigi Brustenghi
- Stroke Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy; (M.A.); (L.B.); (P.B.); (A.G.); (M.M.); (S.M.); (V.P.); (M.Z.)
| | - Arianna Guidubaldi
- Stroke Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy; (M.A.); (L.B.); (P.B.); (A.G.); (M.M.); (S.M.); (V.P.); (M.Z.)
| | - Mariangela Maiotti
- Stroke Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy; (M.A.); (L.B.); (P.B.); (A.G.); (M.M.); (S.M.); (V.P.); (M.Z.)
| | - Sara Micheli
- Stroke Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy; (M.A.); (L.B.); (P.B.); (A.G.); (M.M.); (S.M.); (V.P.); (M.Z.)
| | - Vilma Pierini
- Stroke Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy; (M.A.); (L.B.); (P.B.); (A.G.); (M.M.); (S.M.); (V.P.); (M.Z.)
| | - Alessio Gamboni
- Emergency Department, San Giovanni Battista Hospital, 06034 Foligno, Italy; (A.G.); (G.C.); (C.B.)
| | - Giuseppe Calabrò
- Emergency Department, San Giovanni Battista Hospital, 06034 Foligno, Italy; (A.G.); (G.C.); (C.B.)
| | - Chiara Busti
- Emergency Department, San Giovanni Battista Hospital, 06034 Foligno, Italy; (A.G.); (G.C.); (C.B.)
| | - Cesare Magistrato
- Emergency Department, Santa Maria della Stella Hospital, 05018 Orvieto, Italy;
| | | | - Massimo Bracaccia
- Emergency Department and Internal Medicine, Santa Maria della Stella Hospital, 05018 Orvieto, Italy;
| | - Valeria Caso
- Stroke Unit, Santa Maria Misericordia Hospital, 06129 Perugia, Italy;
| | - Mauro Zampolini
- Stroke Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy; (M.A.); (L.B.); (P.B.); (A.G.); (M.M.); (S.M.); (V.P.); (M.Z.)
| |
Collapse
|
11
|
Kim GJ, Kim H, Fletcher J, Voelbel GT, Goverover Y, Chen P, O'Dell MW, Genova HM. The differential impact of the COVID-19 pandemic on healthcare utilization disruption for community-dwelling individuals with and without acquired brain injury. Arch Rehabil Res Clin Transl 2021; 4:100176. [PMID: 34934940 PMCID: PMC8677629 DOI: 10.1016/j.arrct.2021.100176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
All groups experienced notable disruption in health care utilization. Disruption in care for traumatic brain injury or mental health was associated with decreased health-related quality of life. Telehealth was a viable alternative to in-person visits. Telehealth is not a panacea and should be adopted using a nuanced approach.
Objective To delineate health care disruption for individuals with acquired brain injury (ABI) during the peak of the pandemic and to understand the impact of health care disruption on health-related quality of life (HRQoL). Design Cross-sectional survey. Setting General community. Participants Volunteer sample of adults with traumatic brain injury (TBI; n=33), adults with stroke (n=66), and adults without TBI or stroke (n=108) with access to the internet and personal technology (N=207). Interventions Not applicable. Main Outcome Measures Not applicable. Results Participants with TBI and stroke reported high rates of disruption in care specific to their diagnosis (53%-54.5%), while participants across all groups reported disruption for major medical care (range, 68.2%-80%), general health care (range, 60.3%-72.4%), and mental health care (range, 31.8%-83.3%). During the pandemic, participants with TBI and stroke used telehealth for care specific to their diagnosis (40.9%-42.4%), whereas all participants used telehealth for major medical care (range, 50%-86.7%), general health care (range, 31.2%-53.3%), and mental health care (range, 53.8%-72.7%). Disruption in TBI or stroke care and type of ABI explained 27.1% of the variance in HRQoL scores (F2,95=16.82, P<.001, R2=0.262), and disruption in mental health care explained 14.8% of the variance (F1,51=8.86, P=.004, R2=0.148). Conclusions Individuals with and without ABI experienced pronounced disruption in health care utilization overall. However, individuals who experienced a disruption in care specific to TBI or mental health care were most vulnerable to decreased HRQoL. Telehealth was a viable alternative to in-person visits for individuals with and without ABI, but limitations included difficulty with technology, difficulty with comprehensive examination, and decreased rapport with providers.
Collapse
Affiliation(s)
- Grace J Kim
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY.,Department of Rehabilitation Medicine, NYU Langone Health, New York, NY
| | - Hayejin Kim
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
| | | | - Gerald T Voelbel
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY.,Department of Rehabilitation Medicine, NYU Langone Health, New York, NY
| | - Yael Goverover
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
| | - Peii Chen
- Kessler Foundation, West Orange and East Hanover, New Jersey.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY
| | - Helen M Genova
- Kessler Foundation, West Orange and East Hanover, New Jersey.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey
| |
Collapse
|
12
|
Everard G, Luc A, Doumas I, Ajana K, Stoquart G, Edwards MG, Lejeune T. Self-Rehabilitation for Post-Stroke Motor Function and Activity-A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2021; 35:1043-1058. [PMID: 34696645 DOI: 10.1177/15459683211048773] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Due to an increasing stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there is a rise in demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands.Objective. The primary aim of this meta-analysis was to determine the effect of self-rehabilitation on motor outcomes, in comparison to conventional rehabilitation, among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours), and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effect of self-rehabilitation.Methods. Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥5.Results. Thirty-five trials were selected (2225 participants) and included in quantitative synthesis regarding motor outcomes. Trials had a median PEDro Score of 7 [6-8]. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage, and intervention design did not appear to have a significant influence on outcomes.Conclusion. This meta-analysis showed low to moderate evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.
Collapse
Affiliation(s)
- Gauthier Everard
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Alexandre Luc
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium
| | - Ioannis Doumas
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Khawla Ajana
- Psychological Sciences Research Institute (IPSY), 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Gaëtan Stoquart
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Martin Gareth Edwards
- Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Psychological Sciences Research Institute (IPSY), 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
13
|
Busti C, Gamboni A, Calabrò G, Zampolini M, Zedde M, Caso V, Corea F. Telestroke: Barriers to the Transition. Front Neurol 2021; 12:689191. [PMID: 34594291 PMCID: PMC8476832 DOI: 10.3389/fneur.2021.689191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/27/2021] [Indexed: 01/17/2023] Open
Affiliation(s)
- Chiara Busti
- Emergency Department, San Giovanni Battista Hospital of Foligno, Umbria, Italy
| | - Alessio Gamboni
- Emergency Department, San Giovanni Battista Hospital of Foligno, Umbria, Italy
| | - Giuseppe Calabrò
- Emergency Department, San Giovanni Battista Hospital of Foligno, Umbria, Italy
| | - Mauro Zampolini
- Stroke Unit, San Giovanni Battista Hospital of Foligno, Umbria, Italy
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valeria Caso
- Stroke Unit, Santa Maria Misericordia Hospital, Perugia, Italy
| | - Francesco Corea
- Stroke Unit, San Giovanni Battista Hospital of Foligno, Umbria, Italy
| |
Collapse
|
14
|
Romoli M, Eusebi P, Forlivesi S, Gentile M, Giammello F, Piccolo L, Giannandrea D, Vidale S, Longoni M, Paolucci M, Hsiao J, Sayles E, Yeo LLL, Kristoffersen ES, Chamorro A, Jiao L, Khatri P, Tsivgoulis G, Paciaroni M, Zini A. Stroke network performance during the first COVID-19 pandemic stage: A meta-analysis based on stroke network models. Int J Stroke 2021; 16:771-783. [PMID: 34427480 PMCID: PMC8521356 DOI: 10.1177/17474930211041202] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The effect of the COVID pandemic on stroke network performance is unclear, particularly with consideration of drip&ship vs. mothership models. AIMS We systematically reviewed and meta-analyzed variations in stroke admissions, rate and timing of reperfusion treatments during the first wave COVID pandemic vs. the pre-pandemic timeframe depending on stroke network model adopted. SUMMARY OF FINDINGS The systematic review followed registered protocol (PROSPERO-CRD42020211535), PRISMA and MOOSE guidelines. We searched MEDLINE, EMBASE, and CENTRAL until 9 October 2020 for studies reporting variations in ischemic stroke admissions, treatment rates, and timing in COVID (first wave) vs. control-period. Primary outcome was the weekly admission incidence rate ratio (IRR = admissions during COVID-period/admissions during control-period). Secondary outcomes were (i) changes in rate of reperfusion treatments and (ii) time metrics for pre- and in-hospital phase. Data were pooled using random-effects models, comparing mothership vs. drip&ship model. Overall, 29 studies were included in quantitative synthesis (n = 212,960). COVID-period was associated with a significant reduction in stroke admission rates (IRR = 0.69, 95%CI = 0.61-0.79), with higher relative presentation of large vessel occlusion (risk ratio (RR) = 1.62, 95% confidence interval (CI) = 1.24-2.12). Proportions of patients treated with endovascular treatment increased (RR = 1.14, 95%CI = 1.02-1.28). Intravenous thrombolysis decreased overall (IRR = 0.72, 95%CI = 0.54-0.96) but not in the mothership model (IRR = 0.81, 95%CI = 0.43-1.52). Onset-to-door time was longer for the drip&ship in COVID-period compared to the control-period (+32 min, 95%CI = 0-64). Door-to-scan was longer in COVID-period (+5 min, 95%CI = 2-7). Door-to-needle and door-to-groin were similar in COVID-period and control-period. CONCLUSIONS Despite a 35% drop in stroke admissions during the first pandemic wave, proportions of patients receiving reperfusion and time-metrics were not inferior to control-period. Mothership preserved the weekly rate of intravenous thrombolysis and the onset-to-door timing to pre-pandemic standards.
Collapse
Affiliation(s)
- Michele Romoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, “C.A. Pizzardi” Maggiore Hospital, Bologna, Italy
- Neurology and Stroke Unit, Department of Neuroscience, “Maurizio Bufalini” Hospital, Cesena, Italy
- Neurology Clinic, University of Perugia – S. Maria della Misericordia Hospital, Perugia, Italy
| | - Paolo Eusebi
- Public Health Authority, Regione Umbria, Perugia, Italy
| | - Stefano Forlivesi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, “C.A. Pizzardi” Maggiore Hospital, Bologna, Italy
| | - Mauro Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, “C.A. Pizzardi” Maggiore Hospital, Bologna, Italy
| | - Fabrizio Giammello
- International PhD in Translational Molecular Medicine and Surgery, Department of BIOMORF – University of Messina, Messina, Italy
| | - Laura Piccolo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, “C.A. Pizzardi” Maggiore Hospital, Bologna, Italy
| | - David Giannandrea
- Neurologia e Stroke Unit, Ospedale di Gubbio e Gualdo Tadino, Perugia, Italy
| | - Simone Vidale
- Neurology Unit, Rimini “Infermi” Hospital, AUSL Romagna, Rimini, Italy
| | - Marco Longoni
- Neurology and Stroke Unit, Department of Neuroscience, “Maurizio Bufalini” Hospital, Cesena, Italy
| | - Matteo Paolucci
- Neurology and Stroke Unit, Department of Neuroscience, “Maurizio Bufalini” Hospital, Cesena, Italy
| | - Jessica Hsiao
- Department of Neurology, University of Cincinnati, USA
| | - Emily Sayles
- Department of Neurology, University of Cincinnati, USA
| | - Leonard LL Yeo
- Division of Neurology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Department of General Practice, HELSAM, University of Oslo, Oslo, Norway
| | - Angel Chamorro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain
- “August Pi i Sunyer” Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati, USA
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, Memphis, USA
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maurizio Paciaroni
- Neurology – Stroke Unit, Ospedale San Giuseppe, IRCCS MultiMedica, Milano, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, “C.A. Pizzardi” Maggiore Hospital, Bologna, Italy
| |
Collapse
|
15
|
Rutovic S, Volevach E, Maršálková H, Fumagalli AI, Corea F. What the Aftermath of the Global Pandemic Will Mean for Neurologists. Neurol Int 2021; 13:297-303. [PMID: 34287348 PMCID: PMC8293413 DOI: 10.3390/neurolint13030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Stela Rutovic
- Department of Neurology, University Hospital Dubrava, Avenija Gojka Suska 6, 10000 Zagreb, Croatia
- Correspondence:
| | - Ekaterina Volevach
- International Clinical Research Center, St. Anne’s University Hospital, 60200 Brno, Czech Republic; (E.V.); (H.M.)
| | - Hana Maršálková
- International Clinical Research Center, St. Anne’s University Hospital, 60200 Brno, Czech Republic; (E.V.); (H.M.)
| | | | - Francesco Corea
- Stroke and Neurology Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy;
| |
Collapse
|
16
|
Stirparo G, Oradini-Alacreu A, Migliori M, Villa GF, Botteri M, Fagoni N, Signorelli C, Sechi GM, Zoli A. Public health impact of the COVID-19 pandemic on the emergency healthcare system. J Public Health (Oxf) 2021; 44:e149-e152. [PMID: 34156071 PMCID: PMC8344573 DOI: 10.1093/pubmed/fdab212] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/26/2022] Open
Abstract
Background The Lombardy region has been the Italian region most affected by the coronavirus disease 2019 (COVID-19) pandemic in 2020. The emergency healthcare system was under deep stress throughout the past year due to the admission of COVID-19 patients to the emergency department (ED) and had to be thoroughly reorganized. Methods We performed a retrospective descriptive analysis of patients admitted into the ED recorded in the Lombardy online regional portal called EUOL (Emergenza e Urgenza OnLine). We compared the data registered in the EUOL with the patients admitted to the EDs from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. Results The number of admissions to the ED decreased by 32.5% in 2020 compared with 2019, reaching the lowest number in March and April. However, the percentage of patients hospitalized after ED significantly increased in 2020 compared with 2019 (P < 0.0001), reflecting the management of patients with a more severe clinical condition. More patients arrived at the ED by ambulance in 2020 (21.7% in 2020 versus 15.1% in 2019; P < 0.0001), particularly during March and April. Conclusions This analysis showed the importance of monitoring the pandemic’s evolution in order to treat more critically ill patients, despite a lower number of patients.
Collapse
Affiliation(s)
- G Stirparo
- Faculty of Medicine, School of Public Health - University of Vita-Salute San Raffaele, Milano 20132, Italy.,Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - A Oradini-Alacreu
- Faculty of Medicine, School of Public Health - University of Vita-Salute San Raffaele, Milano 20132, Italy
| | - M Migliori
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - G F Villa
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - M Botteri
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy.,AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili di Brescia, Brescia 25123, Italy
| | - N Fagoni
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili di Brescia, Brescia 25123, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia 25123, Italy
| | - C Signorelli
- Faculty of Medicine, School of Public Health - University of Vita-Salute San Raffaele, Milano 20132, Italy
| | - G M Sechi
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - A Zoli
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| |
Collapse
|
17
|
Gabet A, Grave C, Tuppin P, Chatignoux E, Béjot Y, Olié V. Impact of the COVID-19 pandemic and a national lockdown on hospitalizations for stroke and related 30-day mortality in France: A nationwide observational study. Eur J Neurol 2021; 28:3279-3288. [PMID: 33738913 PMCID: PMC8251122 DOI: 10.1111/ene.14831] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this nationwide study was to assess the impact of the COVID-19 pandemic on stroke hospitalization rates, patient characteristics and 30-day case fatality rates. METHODS All hospitalizations for stroke from January to June of each year from 2017 to 2020 were selected using International Classification of Diseases, 10th revision, codes I60 to I64 in the national hospital discharge database. Patient characteristics and management were described according to three time periods: pre-lockdown, lockdown, and post-lockdown. Weekly incidence rate ratios (IRRs) were computed to compare time trends in the rates of patients hospitalized for stroke as well as in-hospital and 30-day case fatality rates between the years 2017-2019 and 2020. RESULTS In 2020, between weeks 1 and 24, 55,308 patients were hospitalized for stroke in France. IRRs decreased by up to 30% for all age groups, sex, and stroke types during the lockdown compared to the period 2017-2019. Patients hospitalized during the second and third weeks of the lockdown had higher in-hospital case fatality rates compared to 2017-2019. In-hospital case fatality rates increased by almost 60% in patients aged under 65 years. Out-of-hospital 30-day case fatality rates increased between weeks 11 and 15 among patients who returned home after their hospitalization. Important changes in care management were found, including fewer stroke patients admitted to resuscitation units, more admitted to stroke care units, and a shorter mean length of hospitalization. CONCLUSIONS During the first weeks of the lockdown, rates of patients hospitalized for stroke fell by 30% and there were substantial increases of both in-hospital and out-of-hospital 30-day case fatality rates.
Collapse
|
18
|
Christensen H, Pezzella FR. Implementation of the Stroke Action Plan for Europe 2018--2030 during coronavirus disease-2019. Curr Opin Neurol 2021; 34:55-60. [PMID: 33278140 DOI: 10.1097/wco.0000000000000893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW To describe the background, principles and implementation of the Stroke Action Plan for Europe 2018--2030 (SAP-E) in the perspective of the current COVID-19 pandemic. RECENT FINDINGS SAP-E sets targets for the implementation of evidence-based preventive actions and stroke services to 2030. A recent mapping of stroke care in Europe has documented massive inequalities and even in high-income European countries access to reperfusion therapy and mortality after ischaemic stroke varies significantly. Organized stroke care providing stroke unit care and access to reperfusion therapies reduces mortality and long-term disability. Stroke prevention and care are highly cost-effective. The COVID-19 pandemic has challenged organized care, diverged attention from stroke and necessitated a novel approach to the implementation program because of the continued need for social distancing and reduced travelling. Consequently, meetings, training and engagement will be handled by online resources. SUMMARY Stroke can be prevented and treated but there remain massive inequalities in Europe. SAP-E has set targets for development of stroke care. COVID-19 pandemic has led to further challenges for stroke care and implementation of the Action Plan will rely on online meetings and resources as it is yet unforeseeable when things will return to normal. VIDEO ABSTRACT http://links.lww.com/CONR/A53.
Collapse
Affiliation(s)
- Hanne Christensen
- Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
19
|
Hubert GJ, Corea F, Schlachetzki F. The role of telemedicine in acute stroke treatment in times of pandemic. Curr Opin Neurol 2021; 34:22-26. [PMID: 33230037 DOI: 10.1097/wco.0000000000000887] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 (COVID-19) pandemic challenges many healthcare systems. This review provides an overview of the advantages of telemedicine during times of pandemic and the changes that have followed the outbreak of the COVID-19 disease. RECENT FINDINGS Telemedicine has been utilized during infectious outbreaks for many years. COVID-19 has induced a variety of changes in laws (i.e. data privacy protection) and reimbursement procedures to accelerate new setups of telemedicine. Existing networks provide novel data about teleactivation resulting from social restrictions during the nadir of the lockdown in spring 2020. SUMMARY Telemedicine is a safe and ideal expert support system for hospitals during infectious outbreaks. It makes high-quality medical procedures possible, limits potentially contagious interhospital transfers, saves critical resources such as protective gear and rescue/emergency transport services, and offers safe home office work for medical specialists.
Collapse
Affiliation(s)
- Gordian J Hubert
- TEMPiS Telemedical Stroke Center, Department of Neurology, München Klinik Harlaching, Munich, Germany
| | - Francesco Corea
- Stroke and Neurology Clinic, San Giovanni Battista Hospital, Foligno, Italy
| | - Felix Schlachetzki
- TEMPiS Telemedical Stroke Center, Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, Medbo Bezirksklinikum
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 (COVID-19) pandemic has caused a major impact on stroke care. This review synthesizes the available data and provides a framework for optimal management of stroke patients with confirmed or suspected COVID-19 infection and eligible to reperfusion treatments. RECENT FINDINGS Reorganization of health services has led to the conversion of stroke units and relocation of stroke staff to COVID units. During the pandemic surge, there has been a general decline of stroke presentations, increased time delays, and reduced activity across all areas of stroke care, specifically the delivery of acute treatment. Moreover, COVID-19 patients seem to have a worse outcome despite prompt recanalization. Periprocedural monitoring studies are needed in these patients to target a more adequate therapy. SUMMARY The COVID-19 pandemic has jeopardized the ability of stroke centers to provide timely assessment and acute therapies such as reperfusive treatments. Yet, as stroke remains a medical emergency, efforts to maintain stroke teams and safe provision of highly effective stroke treatments should be prioritized despite healthcare systems reorganization. This can be accomplished through the activation of telestroke networks, protected stroke pathways, 24/7 open-access high-quality stroke centers, and stroke awareness programs.
Collapse
Affiliation(s)
- Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, Padua University Hospital, Padua, Italy
| | | |
Collapse
|
21
|
Editorial: Coronavirus disease 2019 and stroke: how to avoid a new lockdown for stroke patients. Curr Opin Neurol 2021; 34:1-2. [PMID: 33278147 DOI: 10.1097/wco.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Telemedicine during the Coronavirus Disease (COVID-19) Pandemic: A Multiple Sclerosis (MS) Outpatients Service Perspective. Neurol Int 2021; 13:25-31. [PMID: 33477432 PMCID: PMC7839012 DOI: 10.3390/neurolint13010003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/21/2022] Open
Abstract
Background: During the COVID-19 pandemic, the need for a broader implementation of telemedicine for many diseases has become apparent. Televisits are one type of telemedicine in which clinical visits are conducted remotely using an audio-visual connection with the patient at home. The use of televisits is more established in Stroke care but was also recently formally evaluated for Multiple Sclerosis (MS). This retrospective case series describes patient characteristics and reasons for televisits in persons with MS during the COVID-19 pandemic outbreak in Italy, which was declared in February 2020. Methods: Recruitment occurred in a general hospital based MS clinic during Italy’s lockdown months period (9 March–18 May). Each subject completed at least one televisit. The baseline data included were demographics and MS history; reasons for the remote house calls were analyzed focusing on COVID-19 related needs. Results: Forty-six participants completed at least one study visit. The patients enrolled were more often females suffering from Relapsing Remitting Multiple Sclerosis (RRMS). Half of the patients had an intermediate level of education and lived within a 60 min drive from the clinic. These patients predominately had a short disease duration and were mostly involved in oral treatment. The main reasons for the call were drug use and counseling on social distancing. In 5 cases, COVID-19 infection was reported. Conclusions: Televisits during the COVID-19 outbreak demonstrated their utility as a care delivery method for MS. Hence, it is vital to facilitate the implementation of this technology in common practice to both face infectious threats and increase accessibility of the health care system.
Collapse
|
23
|
Zullo S, Ingravallo F, Crespi V, Cascioli M, D'Alessandro R, Gasperini M, Lalli C, Lugaresi A, Marogna M, Mori M, Pesci I, Pistoia F, Porteri C, Vedovello M, Veronese S, Pucci E, Solari A. The impact of the COVID-19 pandemic on people with neurological disorders: an urgent need to enhance the health care system's preparedness. Neurol Sci 2021; 42:799-804. [PMID: 33433758 PMCID: PMC7801877 DOI: 10.1007/s10072-020-04984-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Silvia Zullo
- Department of Legal Studies, University of Bologna, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Vittorio Crespi
- Ethics Committee "Brianza", S. Gerardo Hospital, Monza, Italy
| | - Marta Cascioli
- Hospice 'La Torre sul Colle', Azienda USL Umbria 2, Spoleto, Italy
| | - Roberto D'Alessandro
- Servizio di Epidemiologia e Biostatistica, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marcella Gasperini
- Rehabilitation Department, Marzana Hospital, AULSS 9 (VR), Marzana, Italy
| | | | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Maura Marogna
- SC Neurologia, Ospedale Villa Scassi ASL3, Genoa, Italy
| | - Maurizio Mori
- Dipartimento di filosofia e scienze dell'educazione, University of Turin, Turin, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, Ospedale di Vaio, Fidenza, PR, Italy
| | - Francesca Pistoia
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Corinna Porteri
- Bioethics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | | | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| |
Collapse
|
24
|
Gdovinová Z, Vitková M, Baráková A, Cvopová A. The impact of the COVID-19 outbreak on acute stroke care in Slovakia: Data from across the country. Eur J Neurol 2020; 28:3263-3266. [PMID: 33185918 DOI: 10.1111/ene.14640] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/26/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE A few studies using data from regional databases have recently pointed to a decreased number of patients with stroke. The aim of the present study was to describe country-level data (the number of patients with stroke, the proportion of patients with acute stroke and transient ischemic attack (TIA), the proportion of patients treated with intravenous thrombolysis [IVT] or mechanical thrombectomy [MT], the door-to-needle times [DNT], and the onset-to-needle time [ONT]) during the COVID-19 pandemic in Slovakia. METHODS The study examined data from the stroke register at the National Health Information Centre. Data from three time periods (March to April 2020; March to April 2019; January to February 2020) were compared using an independent samples t-test and the Wilcoxon-Mann-Whitney two-sample rank-sum test. RESULTS The number of stroke patients admitted to hospitals in Slovakia during the COVID-19 period showed a decrease (1673 vs. 2328 in period 2 and 2155 in period 3). The proportions of patients with TIA remained the same in periods 1 and 2 (9.7% vs. 11.7%) and in periods 1 and 3 (9.7 vs. 11.8%). The percentage of patients treated with IVT during the pandemic (22.4%) did not differ from period 2 (20.0%) or period 3 (21.4%). No difference was found in the rate of MT between the COVID-19 period (10.2%) and the same period in 2019 (10.7%) and in January to February 2020 (13.1%). The median DNT remained unchanged in periods 1 (30 min), 2 (35 min) and 3 (30 min), and no differences were found in median ONT in periods 1 (130 min), 2 (130 min) and 3 (140 min). CONCLUSION We found a decreased number of stroke patients during the COVID-19 outbreak in Slovakia, but no evidence of a change in the quality of acute stroke care.
Collapse
Affiliation(s)
- Zuzana Gdovinová
- Department Neurology, Faculty of Medicine, P.J. Safarik University and University Hospital L. Pasteur, Košice
| | - Marianna Vitková
- Department Neurology, Faculty of Medicine, P.J. Safarik University and University Hospital L. Pasteur, Košice
| | - Anna Baráková
- National Health Information Center, Bratislava, Slovakia
| | - Alena Cvopová
- National Health Information Center, Bratislava, Slovakia
| |
Collapse
|
25
|
Fraiman P, Godeiro Junior C, Moro E, Cavallieri F, Zedde M. COVID-19 and Cerebrovascular Diseases: A Systematic Review and Perspectives for Stroke Management. Front Neurol 2020; 11:574694. [PMID: 33250845 PMCID: PMC7674955 DOI: 10.3389/fneur.2020.574694] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023] Open
Abstract
Importance: Reported cerebrovascular events in patients with COVID-19 are mainly ischemic, but hemorrhagic strokes and cerebral venous sinus thrombosis (CSVT), especially in critically ill patients, have also been described. To date, it is still not clear whether cerebrovascular manifestations are caused by direct viral action or indirect action mediated by inflammatory hyperactivation, and in some cases, the association may be casual rather than causal. Objective: To conduct a systematic review on the cerebrovascular events in COVID-19 infection. Evidence review: A comprehensive literature search on PubMed was performed including articles published from January 1, 2020, to July 23, 2020, using a suitable keyword strategy. Additional sources were added by the authors by reviewing related references. The systematic review was conducted in accordance with the PRISMA guidelines. Only articles reporting individual data on stroke mechanism and etiology, sex, age, past cardiovascular risk factors, COVID symptoms, admission NIHSS, D-dimer levels, and acute stroke treatment were selected for the review. Articles that did not report the clinical description of the cases were excluded. A descriptive statistical analysis of the data collected was performed. Finding: From a total of 1,210 articles published from January 1, 2020, to July 23, 2020, 80 articles (275 patients), which satisfied the abovementioned criteria, were included in this review. A total of 226 cases of ischemic stroke (IS), 35 cases of intracranial bleeding, and 14 cases of CVST were found. Among patients with IS, the mean age was 64.16 ±14.73 years (range 27-92 years) and 53.5% were male. The mean NIHSS score reported at the onset of stroke was 15.23 ±9.72 (range 0-40). Primary endovascular thrombectomy (EVT) was performed in 24/168 patients (14.29%), intravenous thrombolysis (IVT) was performed in 17/168 patients (10.12%), and combined IVT+EVT was performed in 11/168 patients (6.55%). According to the reported presence of large vessel occlusion (LVO) (105 patients), 31 patients (29.52%) underwent primary EVT or bridging. Acute intracranial bleeding was reported in 35 patients: 24 patients (68.57%) had intracerebral hemorrhage (ICH), 4 patients (11.43%) had non-traumatic subarachnoid hemorrhage (SAH), and the remaining 7 patients (20%) had the simultaneous presence of SAH and ICH. Fourteen cases of CVST were reported in the literature (50% males), mean age 42.8 years ±15.47 (range 23-72). Treatment was reported only in nine patients; seven were treated with anticoagulant therapy; one with acetazolamide, and one underwent venous mechanical thrombectomy. Conclusion: Cerebrovascular events are relatively common findings in COVID-19 infection, and they could have a multifactorial etiology. More accurate and prospective data are needed to better understand the impact of cerebrovascular events in COVID-19 infection.
Collapse
Affiliation(s)
- Pedro Fraiman
- Division of Neurology, Hospital Universitario Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Clecio Godeiro Junior
- Division of Neurology, Hospital Universitario Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Elena Moro
- Division of Neurology, Centre Hospitalier Universitaire of Grenoble, Grenoble Institut of Neuroscience, Grenoble Alpes University, Grenoble, France
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda Unitá Sanitaria Locale - Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda Unitá Sanitaria Locale - Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
26
|
Plumereau C, Cho TH, Buisson M, Amaz C, Cappucci M, Derex L, Ong E, Fontaine J, Rascle L, Riva R, Schiavo D, Benhamed A, Douplat M, Bony T, Tazarourte K, Tuttle C, Eker OF, Berthezène Y, Ovize M, Nighoghossian N, Mechtouff L. Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network. J Neurol 2020; 268:2314-2319. [PMID: 32902732 PMCID: PMC7479751 DOI: 10.1007/s00415-020-10199-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 01/13/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period. Methods We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods. Results A total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period [55 (54.5%) vs 74 (69.2%); p = 0.03]. The volume of MT remains stable over the two periods [72 (71.3%) vs 65 (60.8%); p = 0.14], but the door-to-groin puncture time increased in patients transferred for MT (237 [187–339] vs 210 [163–260]; p < 0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133–2238] vs 1023 [960–1410]; p < 0.01). Conclusions Our study showed a decrease in the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.
Collapse
Affiliation(s)
- Cécile Plumereau
- Emergency Department, Hospices Civils de Lyon, Lyon, France.,Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Matteo Cappucci
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Elodie Ong
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Julia Fontaine
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Lucie Rascle
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Roberto Riva
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - David Schiavo
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Axel Benhamed
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Marion Douplat
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Thomas Bony
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Karim Tazarourte
- Emergency Department, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Célia Tuttle
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Omer Faruk Eker
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Michel Ovize
- CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.,Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France. .,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.
| |
Collapse
|