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Burton E, Aladkhen J, O'Donnell C, Masterson S, Merwick Á, McCarthy VJ, Kearney PM, Buckley CM. Effects of the COVID-19 Pandemic on Prehospital Emergency Care for Adults with Stroke and Transient Ischaemic Attack: A Systematic Review and Meta-Analysis. PREHOSP EMERG CARE 2023; 28:803-822. [PMID: 37261801 DOI: 10.1080/10903127.2023.2219729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION COVID-19 has challenged global health care systems and resulted in prehospital delays for time-sensitive emergencies, like stroke and transient ischemic attacks (TIA). However, there are conflicting international reports on the level of effect of the pandemic on ambulance response intervals and emergency call volumes for these conditions. OBJECTIVES The purpose of this study was to synthesize the international evidence on the effect of COVID-19 on ambulance response intervals and emergency call volume for suspected stroke and TIA. METHODS Following a published protocol, we conducted a systematic search of six databases through May 31, 2022. We re-ran this search on April 14, 2023, to check for any new papers. We considered for inclusion peer-reviewed quantitative studies comparing prehospital emergency care for adults with suspected stroke/TIA before and during the COVID-19 pandemic. Two authors screened title/abstract and full text articles. One author carried out data extraction, with a random selection of articles being checked by another author. We calculated overall pooled estimates of ambulance intervals (activation, response, patient care, and total prehospital intervals) and stroke/TIA emergency call volume. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Two authors assessed study quality using the appropriate Joanna Briggs Institute tool. We worked with patient and public involvement contributors and clinical and policy stakeholders throughout the review. RESULTS Of 4,083 studies identified, 52 unique articles met the inclusion criteria. Mean response interval (-1.29 min [-2.19 to -0.38]) and mean total prehospital interval (-6.42 min [-10.60 to -2.25]) were shorter in the pre-COVID-19 period, compared to the COVID-19 period. Furthermore, there was a higher incidence rate of emergency call volume for suspected stroke/TIA per day pre-COVID-19 compared with the COVID-19 period (log IRR = 0.17 [0.02 to 0.33]). Ambulance response interval definitions and terminology varied between regions and countries. CONCLUSIONS Our review indicates that prehospital delays for suspected stroke/TIA increased during the COVID-19 pandemic. Furthermore, emergency call volume for suspected stroke/TIA decreased during this period. In order to minimize delays in future pandemics or other health care emergencies future research may involve understanding the potential reasons for these delays.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Johnny Aladkhen
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Cathal O'Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Siobhán Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Áine Merwick
- Department of Neurology, Cork University Hospital, Cork City, Cork, Ireland
| | - Vera Jc McCarthy
- School of Nursing and Midwifery, University College Cork, Cork City, Cork, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Claire M Buckley
- School of Public Health, University College Cork, Cork City, Cork, Ireland
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Van Dusen RA, Abernethy K, Chaudhary N, Paudyal V, Kurmi O. Association of the COVID-19 pandemic on stroke admissions and treatment globally: a systematic review. BMJ Open 2023; 13:e062734. [PMID: 36931673 PMCID: PMC10030289 DOI: 10.1136/bmjopen-2022-062734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has highlighted insufficiencies and gaps within healthcare systems globally. In most countries, including high-income countries, healthcare facilities were over-run and occupied with too few resources beyond capacity. We carried out a systematic review with a primary aim to identify the influence of the COVID-19 pandemic on the presentation and treatment of stroke globally in populations≥65 years of age. DESIGN A systematic review was completed. In total, 38 papers were included following full-text screening. DATA SOURCES PubMed, MEDLINE and Embase. ELIGIBILITY CRITERIA Eligible studies included observational and real-world evidence publications with a population who have experienced stroke treatment during the COVID-19 pandemic. Exclusion criteria included studies comparing the effect of the COVID-19 infection on stroke treatment and outcomes. DATA EXTRACTION AND SYNTHESIS Primary outcome measures extracted were the number of admissions, treatment times and patient outcome. Secondary outcomes were severity on admission, population risk factors and destination on discharge. No meta-analysis was performed. RESULTS This review demonstrated that 84% of studies reported decreased admissions rates during the COVID-19 pandemic. However, among those admitted, on average, had higher severity of stroke. Additionally, in-hospital stroke treatment pathways were affected by the implementation of COVID-19 protocols, which resulted in increased treatment times in 60% of studies and increased in-hospital mortality in 82% of studies by 100% on average. The prevalence of stroke subtype (ischaemic or haemorrhagic) and primary treatment methods (thrombectomy or thrombolysis) did not vary due to the COVID-19 pandemic. CONCLUSIONS During the COVID-19 pandemic, many populations hesitated to seek medical attention, decreasing hospital admissions for less severe strokes and increasing hospitalisation of more severe cases and mortality. The effect of the pandemic on society and healthcare systems needs to be addressed to improve stroke treatment pathways and prepare for potential future epidemics. PROSPERO REGISTRATION NUMBER CRD42021248564.
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Affiliation(s)
| | - Kiera Abernethy
- Physical and environmenal science, University of Toronto, Toronto, Ontario, Canada
| | | | - Vibhu Paudyal
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Om Kurmi
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty Centre for Intelligent Healthcare, Coventry University, Coventry, UK
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Nexus Institute of Research and Innovation, Lalitpur, Nepal
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Melaika K, Sveikata L, Vilionskis A, Wiśniewski A, Jurjans K, Klimašauskas A, Jatužis D, Masiliūnas R. Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania. Healthcare (Basel) 2022; 10:healthcare10101958. [PMID: 36292405 PMCID: PMC9601945 DOI: 10.3390/healthcare10101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019 and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics (or 49.4% of all paramedics from our stroke care network) were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8−57.6) vs. 28.1% (95% CI 20.1−27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5−90.5) vs. 69.8% (60.0−78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8−77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0−68.0), brain tumors (56.3%, 95% CI 48.5−63.8), and seizures (54.4%, 95% CI 46.7−62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4−11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusions: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving insufficient feedback on suspected stroke patients, even though its usefulness is perceived as paramount.
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Affiliation(s)
| | - Lukas Sveikata
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Aleksandras Vilionskis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania
| | - Adam Wiśniewski
- Department of Neurology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland
| | - Kristaps Jurjans
- Department of Neurology and Neurosurgery, Riga Stradins University, 1002 Riga, Latvia
- Department of Neurology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia
| | - Andrius Klimašauskas
- Center of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University, 08661 Vilnius, Lithuania
| | - Dalius Jatužis
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania
| | - Rytis Masiliūnas
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania
- Correspondence: ; Tel.: +370-688-62356; Fax: +370-688-62728
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Huabbangyang T, Klaiangthong R, Prasittichok K, Koikhunthod S, Wanna J, Sudajun N, Khaisri P, Kamsom A. Comparing Emergency Medical Services Processing Times for Stroke Patients Before and During COVID-19 Pandemic; A Cross-sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e65. [PMID: 36381971 PMCID: PMC9637259 DOI: 10.22037/aaem.v10i1.1710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has directly affected global healthcare, especially the front-line of healthcare provision, including emergency medical services (EMS). The present study aimed to compare EMS processing times and the number of acute stroke patients serviced by EMS before and during COVID-19 pandemic. METHODS This is a retrospective observational review of Bangkok Surgico Medical Ambulance and Rescue Team (S.M.A.R.T.) EMS data from 2018 to 2021. The EMS processing times and the number of acute strokes were compared between pre-COVID-19 era (January 1st, 2018, and December 31st, 2019) and during COVID-19 pandemic (January 1st, 2020, and December 31st, 2021). RESULTS The number of stroke patients transported by EMS in one year, before and during COVID-19 pandemic was 128 and 150 cases, respectively (Change difference = 17.2%, 95% CI: 11.1-24.9). However, the average number of acute stroke patients per week was not significantly different (p = 0.386). The mean total EMS processing times before and during COVID-19 era were 25.59 ± 11.12 and 45.47 ± 14.61 minutes, respectively (mean difference of 19.88 (95% CI: 16.77-22.99) minutes; p < 0.001). The mean time from symptom onset to EMS arrival (p < 0.001), the mean call time (p < 0.001), the mean response time (p < 0.001), and the mean scene time (p < 0.001) were significantly higher during COVID-19 period. The mean transportation times for stroke patients was similar before and during COVID-19 pandemic (10.14 ± 6.28 and 9.41 ± 6.31 minutes, respectively; p = 0.338). CONCLUSIONS During COVID-19 pandemic, the number of acute stroke patients serviced by EMS increased substantially, but there was no difference in the average number of patients per week. During the pandemic, EMS processing times markedly increased.
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Affiliation(s)
- Thongpitak Huabbangyang
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Rossakorn Klaiangthong
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand.,Corresponding author: Rossakorn Klaiangthong; Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok 10400, Thailand. Tel: +66 2-244-3000,
| | - Krit Prasittichok
- Department of Research and Medical Innovation, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sutida Koikhunthod
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Jakkapan Wanna
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Nutthapong Sudajun
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Parichat Khaisri
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Anucha Kamsom
- Division of Biostatistic, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Burton E, Aladkhen J, O’Donnell C, Masterson S, Merwick A, McCarthy VJC, Kearney PM, Buckley CM. Effects of the COVID-19 pandemic on prehospital emergency care for adults with stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis. HRB Open Res 2022; 5:24. [PMID: 35859688 PMCID: PMC9266003 DOI: 10.12688/hrbopenres.13534.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on healthcare delivery as they require immediate diagnosis and treatment. The global impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA is still largely unknown. Thus, the aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke and TIA. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review is registered on PROSPERO (registration number CRD42022315260). Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic will be considered for inclusion. The outcomes of interest are ambulance times and emergency call volumes for stroke/TIA. A systematic search of databases including PubMed, Embase and Scopus will be conducted. Two authors will independently screen studies for inclusion based on predetermined inclusion and exclusion criteria. Data extraction and quality assessment will be conducted by two authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate. Where heterogeneity is low a fixed-effects model will be used and where heterogeneity is high a random-effects model will be used. Subgroup and sensitivity analyses will include location, stroke/TIA diagnosis and COVID-19 case numbers. Results: Data on primary and secondary outcomes will be provided. Results of subgroup/sensitivity analyses and quality assessment will also be presented. Conclusions: This review will identify existing evidence reporting the impact of the COVID-19 pandemic on prehospital emergency care for adult patients with stroke/TIA and provide summary estimates of effects on ambulance response times.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Johnny Aladkhen
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Cathal O’Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Siobhán Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Aine Merwick
- Department of Neurology, Cork University Hospital, Cork City, Cork, Ireland
| | - Vera JC McCarthy
- School of Nursing and Midwifery, University College Cork, Cork City, Cork, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Claire M Buckley
- School of Public Health, University College Cork, Cork City, Cork, Ireland
- Office of the NCAGL for Chronic Disease, Health Service Executive South East, Lacken, Dublin Road, Kilkenny, R95 NV08, Ireland
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Araja D, Berkis U, Murovska M. COVID-19 Pandemic-Revealed Consistencies and Inconsistencies in Healthcare: A Medical and Organizational View. Healthcare (Basel) 2022; 10:healthcare10061018. [PMID: 35742069 PMCID: PMC9223168 DOI: 10.3390/healthcare10061018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 12/17/2022] Open
Abstract
The circumstances of the Coronavirus disease caused by the SARS-CoV-2 virus (COVID-19) pandemic have had a significant impact on global and national developments, affecting the existence of society in all its expressions, as well as the lives of people themselves. In the context of the pandemic, increased attention has been focused on acute measures, but the ending of the pandemic is expected as a resolution of the related healthcare problems. However, there are several indicators that the COVID-19 pandemic might induce long-term consequences for individual and public health. Some of the consequences are inferred and predictable, but there are also areas of medicine that have been indirectly affected by the pandemic, and these consequences have not yet been sufficiently explored. This study is focused on drawing attention to some of the COVID-19 pandemic consistencies and the pandemic-revealed inconsistencies in healthcare. Content analysis and statistical analysis were applied to achieve the aim of the study. The main findings of the study address chronic disease burden (particularly, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)), healthcare governance and organizational issues, and the synergy between health policy perspectives and innovative solutions in practice. The study provides insight into the particular healthcare issues affected by the COVID-19 pandemic, such as the increase in mortality in some diagnoses besides COVID-19 and the possible emergence of a new type of resistance—vaccine-resistance—contemporaneously supporting the identification of the tendencies and currently unnoticed indirect consistencies and inconsistencies revealed by the pandemic.
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Jurkevičienė J, Vaišvilas M, Masiliūnas R, Matijošaitis V, Vaitkus A, Geštautaitė D, Taroza S, Puzinas P, Galvanauskaitė E, Jatužis D, Vilionskis A. Reperfusion Therapies for Acute Ischemic Stroke in COVID-19 Patients: A Nationwide Multi-Center Study. J Clin Med 2022; 11:jcm11113004. [PMID: 35683393 PMCID: PMC9181080 DOI: 10.3390/jcm11113004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/07/2022] Open
Abstract
(1) Background: Acute ischemic stroke (AIS) is a possible complication of the coronavirus disease 2019 (COVID-19). Safety and efficacy data on reperfusion therapies (RT)—intravenous thrombolysis and endovascular treatment (EVT)—in stroke patients with COVID-19 is lacking. (2) Methods: We performed a retrospective nationwide multi-center pair-matched analysis of COVID-19 patients with AIS who underwent RT. We included adult COVID-19 patients with AIS who were treated with RT between 16 March 2020 and 30 June 2021. All subjects were paired with non-infected controls, matched for age, sex, stroke arterial vascular territory, and RT modality. The primary outcome measure was a favorable functional outcome defined by the modified Rankin scale (mRS 0–2). (3) Results: Thirty-one subjects and thirty-one matched controls were included. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was higher in the COVID-19 group (16 vs. 12, p = 0.028). Rates of ischemic changes and symptomatic intracerebral hemorrhages did not differ significantly between the two groups at 24 h after RT. The median NIHSS 24 h after reperfusion remained significantly higher in the COVID-19 group (16 vs. 5, p = 0.003). MRS 0–2 at discharge was significantly less common in COVID-19 patients (22.6% vs. 51.8%, p = 0.018). Three-month mortality was 54.8% in the COVID-19 group versus 12.9% in controls (p = 0.001). (4) Conclusion: Reperfusion therapies on AIS in COVID-19 patients appear to be safe; however, functional outcomes are significantly worse, and 3-month mortality is higher.
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Affiliation(s)
- Justina Jurkevičienė
- Stroke Centre, Republican Vilnius University Hospital, 04130 Vilnius, Lithuania;
- Correspondence:
| | - Mantas Vaišvilas
- Stroke Centre, Republican Vilnius University Hospital, 04130 Vilnius, Lithuania;
| | - Rytis Masiliūnas
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (R.M.); (D.J.)
| | - Vaidas Matijošaitis
- Department of Neurology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania; (V.M.); (A.V.); (D.G.)
| | - Antanas Vaitkus
- Department of Neurology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania; (V.M.); (A.V.); (D.G.)
| | - Dovilė Geštautaitė
- Department of Neurology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania; (V.M.); (A.V.); (D.G.)
| | - Saulius Taroza
- Laboratory of Behavioral Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, 00135 Palanga, Lithuania;
| | - Paulius Puzinas
- Department of Neurology, Republican Panevėžys Hospital, 35144 Panevėžys, Lithuania;
| | - Erika Galvanauskaitė
- Department of Neurology, Republican Šiauliai Hospital, 76231 Šiauliai, Lithuania;
| | - Dalius Jatužis
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (R.M.); (D.J.)
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Sveikata L, Melaika K, Wiśniewski A, Vilionskis A, Petrikonis K, Stankevičius E, Jurjans K, Ekkert A, Jatužis D, Masiliūnas R. Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time. Front Neurol 2022; 13:765165. [PMID: 35463146 PMCID: PMC9021450 DOI: 10.3389/fneur.2022.765165] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/24/2022] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose Acute stroke treatment outcomes are predicated on reperfusion timeliness which can be improved by better prehospital stroke identification. We aimed to assess the effect of interactive emergency medical services (EMS) training on stroke recognition and prehospital care performance in a very high-risk cardiovascular risk population in Lithuania. Methods We conducted a single-center interrupted time-series study between March 1, 2019 and March 15, 2020. Two-hour small-group interactive stroke training sessions were organized for 166 paramedics serving our stroke network. We evaluated positive predictive value (PPV) and sensitivity for stroke including transient ischemic attack identification, onset-to-door time, and hospital-based outcomes during 6-months prior and 3.5 months after the training. The study outcomes were compared between EMS providers in urban and suburban areas. Results In total, 677 suspected stroke cases and 239 stroke chameleons (median age 75 years, 54.8% women) were transported by EMS. After the training, we observed improved PPV for stroke recognition (79.8% vs. 71.8%, p = 0.017) and a trend of decreased in-hospital mortality (7.8% vs. 12.3, p = 0.070). Multivariable logistic regression models adjusted for age, gender, EMS location, and stroke subtype showed an association between EMS stroke training and improved odds of stroke identification (adjusted odds ratio [aOR] 1.6 [1.1-2.3]) and onset-to-door ≤ 90 min (aOR 1.6 [1.1-2.5]). The improvement of PPV was observed in urban EMS (84.9% vs. 71.2%, p = 0.003), but not in the suburban group (75.0% vs. 72.6%, p = 0.621). Conclusions The interactive EMS training was associated with a robust improvement of stroke recognition, onset to hospital transport time, and a trend of decreased in-hospital mortality. Adapted training strategies may be needed for EMS providers in suburban areas. Future studies should evaluate the long-term effects of the EMS training and identify optimal retraining intervals.
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Affiliation(s)
- Lukas Sveikata
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Adam Wiśniewski
- Department of Neurology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Aleksandras Vilionskis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Stroke Center, Republican Vilnius University Hospital, Vilnius, Lithuania
| | - Kȩstutis Petrikonis
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edgaras Stankevičius
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristaps Jurjans
- Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
- Department of Neurology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Dalius Jatužis
- Center of Neurology, Vilnius University, Vilnius, Lithuania
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Masiliūnas R, Vilionskis A, Bornstein NM, Rastenytė D, Jatužis D. The impact of a comprehensive national policy on improving acute stroke patient care in Lithuania. Eur Stroke J 2022; 7:134-142. [PMID: 35647307 PMCID: PMC9134776 DOI: 10.1177/23969873221089158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/05/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction: Reperfusion therapy (RT) is a mainstay treatment for acute ischemic stroke (AIS). We aimed to evaluate the impact of a comprehensive national policy (CNP) to improve access to RT for AIS patients across Lithuania. Patients and methods: Aggregated anonymized data on AIS cases treated in Lithuanian hospitals between 2006 and 2019 were retrospectively obtained from the Institute of Hygiene and the Stroke Integrated Care Management Committee. Through an interrupted time series analysis, we examined the trends in AIS hospital admissions, RT, and in-hospital case fatality rates prior to the enactment of CNP in 2014, changes immediately after the intervention, and differences in trends between the pre- and post-intervention periods. Mean yearly door-to-needle times were calculated post-intervention. Results: 114,436 cases were treated for AIS in Lithuanian hospitals before, and 65,084 after the government intervention. We observed a significant decreasing post-intervention trend change in AIS hospital admission rate per 100,000 population (regression coefficient ± standard error: β = –16.47 ± 3.95, p = 0.002) and an increasing trend change in the proportion of AIS patients who received reperfusion treatment: intravenous thrombolysis (β = 1.42 ± 0.96, p < 0.001) and endovascular therapy (β = 0.85 ± 0.05, p < 0.001). The proportion of patients treated in stroke centers increased immediately after the intervention (β = 4.95 ± 1.14, p = 0.001), but the long-term post-intervention trend did not change. In addition, there was a significant decreasing trend in all cause in-hospital case fatality rate within primary and comprehensive stroke centers after the intervention (β = –0.60 ± 0.18, p = 0.008) despite its prompt initial immediate increase (β = 1.68 ± 0.73, p = 0.043). The mean countrywide door-to-needle time decreased from 68 min in 2014 to 43 min in 2019. Conclusion: The comprehensive national stroke patient care policy could be associated with an immediate increase in stroke center treatment rate, increased access to RT, and improved stroke care performance measures.
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Affiliation(s)
| | - Aleksandras Vilionskis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Natan M Bornstein
- Neurological Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Daiva Rastenytė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalius Jatužis
- Center of Neurology, Vilnius University, Vilnius, Lithuania
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Burton E, McCarthy VJC, Merwick A, Kearney PM, Buckley CM. Effects of the COVID-19 pandemic on prehospital emergency care for stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis. HRB Open Res 2022; 5:24. [DOI: 10.12688/hrbopenres.13534.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on healthcare delivery as they require immediate diagnosis and treatment. The global impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA is still largely unknown. Thus, the aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke and TIA. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review is registered on PROSPERO (registration number CRD42022315260). Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic will be considered for inclusion. The outcomes of interest are ambulance response times and emergency call volumes for stroke/TIA. A systematic search of databases including PubMed, Embase and Scopus will be conducted. Two authors will independently screen studies for inclusion based on predetermined inclusion and exclusion criteria. Data extraction and quality assessment will be conducted by two authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance response times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate. Where heterogeneity is low a fixed-effects model will be used and where heterogeneity is high a random-effects model will be used. Subgroup and sensitivity analyses will include location, stroke/TIA diagnosis and COVID-19 case numbers. Results Data on primary and secondary outcomes will be provided. Results of subgroup/sensitivity analyses and quality assessment will also be presented. Conclusions This review will identify existing literature reporting the impact of the COVID-19 pandemic on prehospital emergency care for adult patients with stroke/TIA and provide summary estimates of effects on ambulance response times.
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Ishaque N, Butt AJ, Kamtchum-Tatuene J, Nomani AZ, Razzaq S, Fatima N, Vekhande C, Nair R, Akhtar N, Khan K, Saqqur M, Shuaib A. Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis. J Stroke 2022; 24:65-78. [PMID: 35135061 PMCID: PMC8829489 DOI: 10.5853/jos.2021.01571] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/05/2021] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose There are reports of decline in the rates of acute emergency presentations during coronavirus disease 2019 (COVID-19) pandemic including stroke. We performed a meta-analysis of the impact of COVID-19 pandemic on rates of stroke presentations and on rates of reperfusion therapy.Methods Following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, we systematically searched the literature for studies reporting changes in stroke presentations and treatment rates before and during the COVID-19 pandemic. Aggregated data were pooled using meta-analysis with random-effect models.Results We identified 37 observational studies (n=375,657). Pooled analysis showed decline in rates of all strokes (26.0%; 95% confidence interval [CI], 22.4 to 29.7) and its subtypes; ischemic (25.3%; 95% CI, 21.0 to 30.0), hemorrhagic (27.6%; 95% CI, 20.4 to 35.5), transient ischemic attacks (41.9%; 95% CI, 34.8 to 49.3), and stroke mimics (45.6%; 95% CI, 33.5 to 58.0) during months of pandemic compared with the pre-pandemic period. The decline was most evident for mild symptoms (40% mild vs. 25%–29% moderate/severe). Although rates of intravenous thrombolytic (IVT) and endovascular thrombectomy (EVT) decreased during pandemic, the likelihood of being treated with IVT and EVT did not differ between the two periods, both in primary and in comprehensive stroke centers (odds ratio [OR], 1.08; 95% CI, 0.94 to 1.24 and OR, 0.95; 95% CI, 0.83 to 1.09, respectively).Conclusions Rates of all strokes types decreased significantly during pandemic. It is of paramount importance that general population should be educated to seek medical care immediately for stroke-like symptoms during COVID-19 pandemic. Whether delay in initiation of secondary prevention would affect eventual stroke outcomes in the long run needs further study.
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Affiliation(s)
- Noman Ishaque
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Asif Javed Butt
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ali Zohair Nomani
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Red Deer Regional Hospital Center, Red Deer, AB, Canada
| | - Sarah Razzaq
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Nida Fatima
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chetan Vekhande
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Radhika Nair
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Naveed Akhtar
- Division of Neurology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Khurshid Khan
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maher Saqqur
- Department of Neurology, Trillium Health Care, University of Toronto, Mississauga, ON, Canada
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Correspondence: Ashfaq Shuaib Division of Neurology, Department of Medicine, University of Alberta, Edmonton T6G 2G3, AB, Canada Tel: +1-780-248-1660 Fax: +1-780-248-1807 E-mail:
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Haki C, Deniz O. 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. Clin Neurol Neurosurg 2022; 212:107027. [PMID: 34839154 PMCID: PMC8604567 DOI: 10.1016/j.clineuro.2021.107027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This study aimed to investigate the impact of home quarantine in older patients without COVID-19 hospitalized due to neurological disorders. METHODS We consecutively enrolled 255 elderly patients(median age: 75 years, female: 54%), including 180 (70%) in the pre-home quarantine period and 75 (30%) home quarantine period from January to May 2020 (ten weeks before and ten weeks after the March 21, 2020, lockdown for older patients in Turkey) in a tertiary referral neurological center. RESULTS In the home quarantine period, we documented a fall in the number of neurological admissions by 58.3%, but an increased need for intensive care in older patients. Patients in the home quarantine period were younger [73 (65-91) vs 76 (65-95), p = 0.005], had worse Glasgow Coma Scores (12.3 ± 3.6 vs 13.7 ± 2.5, p = 0.007), higher in-hospital mortality rate (21.3% vs. 6.7%, p = 0.001), had a lower prevalence of comorbidities such as diabetes mellitus, hypertension, and cardiovascular disease, and chronic neurologic disease, albeit had a higher prevalence of the acute cerebrovascular disease (hemorrhagic/ ischemic stroke)(90.7% vs 78.9, p = 0.025). In this period, even there was an increase in the proportion of the patients undergoing reperfusion therapy, it wasn't statistically significant (20.3% vs. 10.1%, p: 0.054). Multivariate analysis revealed that high NIHSS (The National Institutes of Health Stroke Scale) score (OR=1.25; p < 0.001) and hospitalization in the home quarantine period (OR=3.21; p = 0.043) were independently associated with in-hospital mortality. CONCLUSION Our study indicated that during the COVID-19 home quarantine period, despite a significantly fewer number of patients admitted to the hospitalization, there was a higher percentage of those hospitalized needing intensive care and an overall worse prognosis.
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Affiliation(s)
- Cemile Haki
- Neurology Clinic, Bursa City Hospital, Bursa, Turkey
| | - Olgun Deniz
- Geriatric Medicine Clinic, Palliative Care Unit, Bursa City Hospital, Bursa, Turkey.
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Grigonyte M, Kraujelyte A, Januskeviciute E, Semys G, Kriukelyte O, Kontrimaviciute E, Valeviciene NR, Jatuzis D. The Impact of the Pandemic on Acute Ischaemic Stroke Endovascular Treatment from a Multidisciplinary Perspective: A Nonsystematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9464. [PMID: 34574386 PMCID: PMC8471435 DOI: 10.3390/ijerph18189464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reduced admissions for cerebrovascular events were identified, but acute ischaemic stroke (AIS) has remained one of the leading causes of death and disability for many years. The aim of this article is to review current literature data for multidisciplinary team (MDT) coordination, rational management of resources and facilities, ensuring timely medical care for large vessel occlusion (LVO) AIS patients requiring endovascular treatment during the pandemic. METHODS A detailed literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: acute ischaemic stroke, emergency, anaesthesia, airway management, mechanical thrombectomy, endovascular treatment, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19. Published studies and guidelines from inception to April 2021 were screened. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 59 were chosen for detailed analysis. RESULTS The pandemic has an impact on every aspect of AIS care, including prethrombectomy, intraprocedural and post-thrombectomy issues. Main challenges include institutional preparedness, increased number of AIS patients with multiorgan involvement, different work coordination principles and considerations about preferred anaesthetic technique. Care of these patients is led by MDT and nonoperating room anaesthesia (NORA) principles are applied. CONCLUSIONS Adequate management of AIS patients requiring mechanical thrombectomy during the pandemic is of paramount importance to maximise the benefit of the endovascular procedure. MDT work and familiarity with NORA principles decrease the negative impact of the disease on the clinical outcomes for AIS patients.
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Affiliation(s)
- Milda Grigonyte
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (M.G.); (A.K.); (E.J.); (G.S.)
| | - Agne Kraujelyte
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (M.G.); (A.K.); (E.J.); (G.S.)
| | - Elija Januskeviciute
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (M.G.); (A.K.); (E.J.); (G.S.)
| | - Giedrius Semys
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (M.G.); (A.K.); (E.J.); (G.S.)
| | - Oresta Kriukelyte
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (M.G.); (A.K.); (E.J.); (G.S.)
| | - Egle Kontrimaviciute
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | - Nomeda Rima Valeviciene
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | - Dalius Jatuzis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
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