The COVID-19 pandemic effect on the prehospital Madrid stroke code metrics and diagnostic accuracy

• Published in: PloS one 2022-01, Vol.17 (10), p.e0275831
• Main Authors: Nicolás Riera-López, Andrea Gaetano-Gil, José Martínez-Gómez, Nuria Rodríguez-Rodil, Borja M Fernández-Félix, Jorge Rodríguez-Pardo, Carmen Cuadrado-Hernández, Emmanuel Pelayo Martínez-González, Alicia Villar-Arias, Fátima Gutiérrez-Sánchez, Pablo Busca-Ostolaza, Eduardo Montero-Ruiz, Exuperio Díez-Tejedor, Javier Zamora, Blanca Fuentes-Gimeno, Madrid Stroke Network
• Format: Article
• Language: English
• ISSN: 1932-6203
• DOI: 10.1371/journal.pone.0275831

BackgroundOnly very few studies have investigated the effect of the COVID-19 pandemic on the pre-hospital stroke code protocol. During the first wave, Spain was one of the most affected countries by the SARS-CoV-2 coronavirus disease pandemic. This health catastrophe overshadowed other pathologies, such as acute stroke, the leading cause of death among women and the leading cause of disability among adults. Any interference in the stroke code protocol can delay the administration of reperfusion treatment for acute ischemic strokes, leading to a worse patient prognosis. We aimed to compare the performance of the stroke code during the first wave of the pandemic with the same period of the previous year.MethodsThis was a multicentre interrupted time-series observational study of the cohort of stroke codes of SUMMA 112 and of the ten hospitals with a stroke unit in the Community of Madrid. We established two groups according to the date on which they were attended: the first during the dates with the highest daily cumulative incidence of the first wave of the COVID-19 (from February 27 to June 15, 2020), and the second, the same period of the previous year (from February 27 to June 15, 2019). To assess the performance of the stroke code, we compared each of the pre-hospital emergency service time periods, the diagnostic accuracy (proportion of stroke codes with a final diagnosis of acute stroke out of the total), the proportion of patients treated with reperfusion therapies, and the in-hospital mortality.ResultsSUMMA 112 activated the stroke code in 966 patients (514 in the pre-pandemic group and 452 pandemic). The call management time increased by 9% (95% CI: -0.11; 0.91; p value = 0.02), and the time on scene increased by 12% (95% CI: 2.49; 5.93; p value =