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Clinician's Perception of Practice Changes for Stroke During the COVID-19 Pandemic
Hera A Kamdar1, Blake Senay1, Shraddha Mainali1
1Department of Neurology, The Ohio State University, Columbus, Ohio USA.
Insights
COVID-19 significantly altered acute stroke care, with changes in transport, treatment eligibility, and admission practices. Stroke volumes decreased, impacting patient outcomes and highlighting the need for updated guidelines.
Area of Science:
- Neurology
- Public Health
- Healthcare Management
Background:
- The COVID-19 pandemic necessitated rapid adaptations in acute cerebrovascular disease management.
- Practices and policies for stroke care evolved to meet pandemic-related challenges and ensure patient safety.
Purpose of the Study:
- To investigate the changes in acute stroke care practices and policies during the COVID-19 pandemic.
- To assess the impact of these changes on stroke volume and patient outcomes.
Main Methods:
- A 12-question, cross-sectional online survey was distributed to US practitioners involved in acute stroke care.
- The survey targeted national society members, social media networks, and personal contacts.
Main Results:
- 206 surveys were completed by practitioners from 39 states, primarily from comprehensive stroke centers.
- Half of respondents reported changes in transport practices, with 7% noting significant reductions in transfers.
- Common infection control measures included universal personal protective equipment (PPE) use and limiting practitioners in the room.
- 81% observed a decrease in stroke volume, and 34% felt COVID-19 impacted acute stroke patient care or outcomes.
- Changes in transport guidelines, IV-thrombolysis (IV-tPA) or mechanical thrombectomy (MT) eligibility, and post-procedure admission practices were associated with perceived impacts on care.
Conclusions:
- Acute stroke management practices and policies varied significantly across institutions in response to COVID-19.
- A notable reduction in stroke volume was reported nationwide.
- Modifications to hospital transport, IV-tPA, and MT protocols may influence the perceived quality and outcomes of acute stroke care.
Background:
Approach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey.
Methods:
A 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication.
Results:
Respondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P = 0.047, 95% CI: 1.004-1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P = 0.052, 95% CI: 0.988-10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P = 0.023, 95% CI: 1.110-4.132).
Conclusion:
Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. There is also a reported reduction in stroke volume across hospitals. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients.
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