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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Stroke Patients' Characteristics and Clinical Outcomes: A Pre-Post COVID-19 Comparison Study
Hong Chuan Loh1, Kar Keong Neoh2, Angelina Siing Ngi Tang2
1Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia.
Insights
The COVID-19 pandemic did not disrupt acute stroke care in a Malaysian primary stroke center, showing stable patient numbers and increased recanalization therapies. However, low COVID-19 burden in the area may limit generalizability of findings on stroke care during the pandemic.
Area of Science:
- Neurology
- Public Health
- Emergency Medicine
Background:
- The Coronavirus disease 2019 (COVID-19) pandemic significantly impacted global healthcare systems.
- Disruptions to established medical care necessitated evaluating the impact on acute stroke care.
- Primary stroke centers play a crucial role in managing time-sensitive neurological emergencies.
Purpose of the Study:
- To compare admission and outcome variables for ischaemic stroke patients before and during the COVID-19 pandemic.
- To assess changes in the number of patients, stroke severity, and acute recanalisation therapy administration.
- To evaluate workflow metrics in a Malaysian primary stroke centre during the pandemic.
Main Methods:
- A cross-sectional, hospital-based study comparing two six-month periods: pre-COVID-19 (March-September 2019) and COVID-19 (March-September 2020).
- Included adult ischaemic stroke patients, analyzing patient numbers, recanalisation therapy rates, stroke severity (NIHSS), functional outcomes (mRS), and workflow metrics.
- Statistical comparison of outcomes between the two periods.
Main Results:
- Patient numbers remained stable (131 pre-COVID-19 vs. 156 during COVID-19).
- Significantly shorter door-to-scan (24.5 vs. 12.0 min) and door-to-reperfusion (93.5 vs. 60.0 min) times were observed during the COVID-19 period.
- Increased administration of intravenous thrombolysis (7.6% vs. 17.3%) and mechanical thrombectomy (0.8% vs. 6.4%) occurred during the COVID-19 period.
Conclusions:
- The COVID-19 pandemic did not appear to disrupt acute stroke care in this Malaysian primary stroke centre.
- Stable ischaemic stroke incidence, increased recanalisation therapies, and improved workflow metrics were noted.
- Low COVID-19 burden in the study area may limit generalizability; continuous optimization of stroke care services is essential.
Abstract:
Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given pre-post COVID-19 at a primary stroke centre located in Malaysia. Methods: This cross-sectional hospital-based study included adult ischaemic stroke patients. Variables of the study included the number of ischaemic stroke patients, the proportions of recanalisation therapies, stroke severity during admission based on the National Institutes of Health Stroke Scale, functional outcome at discharge based on the modified Rankin Scale, and relevant workflow metrics. We compared the outcome between two six-month periods, namely the pre-COVID-19 period (March 2019 to September 2019) and the COVID-19 period (March 2020 to September 2020). Results: There were 131 and 156 patients, respectively, from the pre-COVID-19 period and the COVID-19 period. The median door-to-scan time and the median door-to-reperfusion time were both significantly shorter in the COVID-19 period (24.5 min versus 12.0 min, p = 0.047) and (93.5 min versus 60.0 min, p = 0.015), respectively. There were also significantly more patients who received intravenous thrombolysis (7.6% versus 17.3%, p = 0.015) and mechanical thrombectomy (0.8% versus 6.4%, p = 0.013) in the COVID-19 period, respectively. Conclusions: The COVID-19 pandemic may not have caused disruptions of acute stroke care in our primary stroke centre. Our data indicated that the number of ischaemic stroke events remained stable, with a significant increase of recanalisation therapies and better in-hospital workflow metrics during the COVID-19 pandemic period. However, we would like to highlight that the burden of COVID-19 cases in the study area was very low. Therefore, the study may not have captured the true burden (and relevant delays in stroke patient management) during the COVID-19 pandemic. The effect of the pandemic crisis is ongoing and both pre-hospital and in-hospital care systems must continue to provide optimal, highly time-dependent stroke care services.
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