Did COVID-19 impact stroke services? A multicenter study

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• Acute stroke services faced disruptions during the COVID-19 pandemic.
• Pandemic-related issues compromised stroke care delivery globally.
• International collaboration is crucial to understand these impacts.

Purpose of the Study:

• To investigate changes in acute stroke services during the COVID-19 pandemic.
• To compare stroke care metrics before and during the pandemic across multiple countries.
• To assess the impact of COVID-19 on stroke treatment times and patient outcomes.

Main Methods:

• Cross-sectional, observational, retrospective study involving eight countries.
• Comparison of one year before and one year during the COVID-19 pandemic.
• Analysis of key performance indicators: onset to door (OTD), door to needle (DTN), door to groin (DTG), hospital stay, National Institute of Health Stroke Scale (NIHSS), and modified Rankin score (mRS).

Main Results:

• Reduced patient numbers, lower median age, and higher admission NIHSS during the pandemic.
• Increased hemorrhagic stroke incidence; OTD and DTG remained unchanged, but DTN time lengthened.
• Decreased rtPA administration, increased thrombectomy frequency, shorter hospital stays, and less favorable mRS outcomes at discharge and 3 months.

Conclusions:

• COVID-19 had variable effects on stroke services, with negative impacts on patient volume, treatment times, and outcomes.
• Some aspects of stroke management, like treatment modality, were less affected.
• Understanding these changes is vital for optimizing acute stroke care during public health crises.