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Acute Stroke Care in the With-COVID-19 Era: Experience at a Comprehensive Stroke Center in Japan

Junpei Koge1, Masayuki Shiozawa1, Kazunori Toyoda1

  • 1Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

Frontiers in Neurology
|February 4, 2021
PubMed

Insights

The COVID-19 pandemic impacted stroke care in Japan, decreasing admissions and prolonging workflow times for reperfusion therapy. Imaging choices also shifted, with CT becoming more prevalent during the pandemic.

Area of Science:

  • Neurology
  • Public Health
  • Emergency Medicine

Background:

  • The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted healthcare systems globally.
  • Stroke care, encompassing prehospital and in-hospital workflows, faced substantial challenges during the pandemic.
  • Japan's State of Emergency (April-May 2020) provides a specific context to evaluate these impacts.

Purpose of the Study:

  • To investigate the effects of the COVID-19 pandemic on a comprehensive stroke center in Japan.
  • To analyze changes in stroke admissions, workflow efficiency, and patient outcomes during the pandemic.
  • To assess shifts in diagnostic imaging modalities used for acute ischemic stroke patients undergoing reperfusion therapy.

Main Methods:

  • Retrospective review of acute ischemic stroke patients admitted between December 2019 and July 2020.
  • Comparison of two periods: pre-COVID-19 (Dec 2019-Mar 2020) and With-COVID-19 (Apr-Jul 2020).
  • Analysis of stroke admissions, workflow times (e.g., door-to-imaging, door-to-thrombolysis), functional outcomes (modified Rankin Scale), and brain imaging modalities.

Main Results:

  • Stroke admissions decreased during the State of Emergency and subsequently increased.
  • Workflow times for reperfusion therapy, specifically door-to-imaging and door-to-thrombolysis, were significantly prolonged in the With-COVID-19 period.
  • Computed tomography (CT) became the predominant imaging modality before reperfusion therapy compared to magnetic resonance imaging (MRI) during the pandemic.

Conclusions:

  • The COVID-19 pandemic demonstrably affected stroke admissions and workflow efficiency at the studied comprehensive stroke center.
  • Workflow delays and a shift towards CT imaging highlight adaptations within stroke care during the pandemic.
  • While workflow metrics changed, functional outcomes at discharge showed no significant difference between the periods.

Keywords:
COVID-19acute ischemic strokemechanical thrombectomyneuroimagingthrombolysis

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