Impact of COVID-19 pandemic on acute stroke care: facing an epidemiological paradox with a paradigm shift

• Published in: Neurological sciences 2021-02, Vol.42 (2), p.399-406
• Main Authors: Paolucci, Matteo, Biguzzi, Sara, Cordici, Francesco, Lotti, Enrico Maria, Morresi, Simonetta, Romoli, Michele, Strumia, Silvia, Terlizzi, Rossana, Vidale, Simone, Menarini, Maurizio, Ruggiero, Maria, Valentino, Alessandro, Longoni, Marco
• Format: Article
• Language: English
• Subjects: Coronaviruses; COVID-19; COVID-19 - prevention & control; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Epidemiology; Humans; Intravenous administration; Italy; Medicine; Medicine & Public Health; Models, Organizational; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Outcome Assessment, Health Care; Pandemics; Physical Distancing; Psychiatry; Public health; Reperfusion; Reperfusion - statistics & numerical data; Retrospective Studies; Stroke; Stroke - therapy; Thrombectomy - statistics & numerical data; Thrombolysis; Thrombolytic Therapy - statistics & numerical data; Time Factors
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-020-04914-4

Background During the coronavirus disease 2019 (COVID-19) outbreak, a decrease of stroke’s hospital admissions and reperfusion therapy has been reported worldwide. This retrospective observational study assessed the volume of stroke cases managed in the Emergency Department (ED) and reperfusion therapies in an Italian stroke network with a high incidence of COVID-19, particularly to evaluate if the in-hospital rerouting and the switch from a drip-and-ship to a mothership model could assure an adequate volume of acute treatments. Methods We compared data from March 2020 with those from previous years and formulated five PICO questions regarding (1) incidence of stroke cases in the ED; (2) relation between stroke cases and COVID-19; (3) differences in the number of reperfusion therapies, (4) in the call-to-needle and door-to-needle times for intravenous thrombolysis, and (5) in the call-to-groin and door-to-groin times for thrombectomy. Results We found (1) a 28% decreased of confirmed stroke cases managed in the ED, (2) a negative correlation between stroke cases in ED and COVID-19 progression ( r s = − .390, p = .030), and (3) a similar number of treatments in March 2020 and March 2019. The adoption of the mothership model (4) did not delay alteplase infusion (median call-to-needle p = .126, median door-to-needle p = .142) but led to (5) a significant reduction in median call-to-groin ( p = .018) and door-to-groin times ( p = .010). Conclusion The “hospital avoidance” of stroke patients during the “stay-at-home” appeals needs to be considered for future public health campaigns. A prompt reorganization of the stroke network can guarantee optimal performances at times of crisis.