Stroke Hospitalization Administration & Monitoring: Routine or COVID-19 Care (SHAMROCC)

Area of Science:

• Neurology
• Critical Care Medicine
• Health Services Research

Background:

• Current guidelines recommend 24-hour critical care monitoring for stroke patients post-reperfusion therapy, but this is not evidence-based.
• The COVID-19 pandemic necessitated a shift to a targeted monitoring protocol, reducing guaranteed 24-hour critical care for these patients.
• This study evaluates complications under the targeted approach versus the previous standard of care.

Purpose of the Study:

• To compare the incidence and timing of complications in stroke patients treated with reperfusion therapy under a targeted monitoring protocol versus standard care.
• To assess if the targeted approach, implemented during the COVID-19 pandemic, affected patient outcomes.
• To determine the association between hospital unit location and complication occurrence.

Main Methods:

• A single-center retrospective cohort study analyzed data from 349 stroke patients.
• Patients treated with thrombolysis and/or endovascular thrombectomy in 2019 (standard care), 2020 (standard care), and 2021 (targeted protocol) were included.
• Data on demographics, complications within 24 hours, and unit location were extracted.

Main Results:

• In 2021, 32% of patients experienced complications within 24 hours, compared to 34% in 2020 and 27% in 2019.
• In 2021, 70% of complications occurred by hour 8, versus 49% in 2020 and 29% in 2019.
• Complication rates were similar between critical care and non-critical care units in 2021 (33% vs. 29%).

Conclusions:

• The targeted monitoring protocol did not lead to a significant increase in the incidence or worsening of complication timing.
• Patient location within the hospital (critical vs. non-critical care) was not associated with complication rates.
• These findings suggest that a targeted approach to monitoring stroke patients post-reperfusion may be a safe alternative to continuous 24-hour critical care.