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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Slump in Hospital Admissions for Stroke, a Fact of an Uncertain Nature That Requires Explanation
José M Ramírez-Moreno1,2,3,4, Juan Carlos Portilla-Cuenca5, Roshan Hariramani-Ramchandani1
1Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain.
Insights
The COVID-19 pandemic significantly reduced stroke care, including fewer stroke code activations and reperfusion therapies, despite increased emergency calls. This highlights a critical public health crisis impacting time-sensitive stroke treatment.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic has disrupted healthcare, particularly for time-sensitive conditions like stroke.
- Stroke units experienced collateral effects on patient care during the pandemic.
- This study compares stroke unit activity in 2019 and 2020, focusing on the state of alarm period.
Purpose of the Study:
- To compare healthcare activity in two stroke units before and during the COVID-19 pandemic.
- To analyze the impact of the state of alarm on stroke care metrics.
- To investigate changes in stroke admissions, treatments, and mortality.
Main Methods:
- Comparative analysis of stroke unit data from 2019 and 2020.
- Data grouped by calendar weeks, with a focus on the 10-week state of alarm period.
- Statistical analysis including Poisson regression to assess changes in key indicators.
Main Results:
- Emergency calls increased by 318% during the state of alarm.
- Stroke code activations decreased (p=0.04), as did overall stroke unit activity.
- Hospitalizations for transient ischemic attacks dropped by 35.7%, reperfusion therapies by 37.5%, and telestroke activity by 28.9%, with increased hospital mortality.
Conclusions:
- The COVID-19 pandemic led to a significant decline in stroke care activity and worse patient outcomes.
- The prolonged pandemic poses a substantial public health challenge for stroke management.
- Further research is needed to understand the complex factors contributing to reduced stroke admissions and their negative consequences.
Abstract:
(1) Background: The impact of the health crisis caused by coronavirus disease 2019 (COVID-19) has provoked collateral effects in the attention to pathologies with time-dependent treatments such as strokes. We compare the healthcare activity of two stroke units in the same periods of 2019 and 2020, with an emphasis on what happened during the state of alarm (SA). (2) Materials and methods. Hospitals in the region implemented contingency plans to contain the pandemic; in this planning, the stroke units were not limited in their operational capacity. The SA was declared on 15 March and remained in place for 10 weeks. For the analysis, the data were grouped by consecutive calendar weeks. (3) Results. When the SA was declared the number of calls to the emergency telephone went from 1225 to 3908 calls per week (318% increase). However, the activation of the stroke code went from 6.6 to 5.0 (p = 0.04) and the activity in both stroke units decreased. The largest drop in hospitalizations was for transient ischemic attacks (TIAs) with 35.7% less, 28 vs. 18, (p = 0.05). Reperfusion therapies fell by 37.5%; Poisson regression model 0.64; (95% confidence interval (CI), 0.43-0.95). The overall activity of the telestroke suffered a reduction of 28.9%. We also observed an increase in hospital mortality. (4) Conclusion. The excessive duration of the pandemic precludes any hope of resolving this public health crisis in the short or medium term. Further studies should be conducted to better understand the multifactorial nature of this dramatic decline in stroke admissions and its negative impact.
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