Impact of the COVID-19 outbreak on acute stroke pathways - insights from the Alsace region in France.
Aged
COVID-19
/ epidemiology
Cerebral Revascularization
/ statistics & numerical data
Female
France
/ epidemiology
Humans
Incidence
Male
Mass Screening
Middle Aged
Pandemics
Retrospective Studies
Stroke
/ epidemiology
Thrombectomy
/ statistics & numerical data
Thrombolytic Therapy
/ statistics & numerical data
Time-to-Treatment
Treatment Outcome
COVID-19
acute stroke pathway
stroke
thrombectomy
thrombolysis
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
21
04
2020
accepted:
05
05
2020
pubmed:
14
5
2020
medline:
18
12
2020
entrez:
14
5
2020
Statut:
ppublish
Résumé
To date, no study has attempted to quantify the impact of the COVID-19 outbreak on the incidence and treatment of acute stroke. This was a retrospective review of acute stroke pathway parameters in all three stroke units in the Alsace region during the first month of the outbreak (1-31 March 2020), using the similar period from 2019 as a comparator. A secondary detailed analysis of all stroke alerts and stroke unit admissions was performed in the centre with the largest case volume. Compared to the same period in 2019, in March 2020 there were 39.6% fewer stroke alerts and 33.3% fewer acute revascularization treatments [40.9% less intravenous thrombolysis (IVT) and 27.6% less mechanical thrombectomy (MT)]. No marked variation was observed in the number of stroke unit admissions (-0.6%). The proportion of patients with acute revascularization treatments (IVT or MT) out of the total number of stroke unit admissions was significantly lower in March 2020 (21.3%) compared to 2019 (31.8%), P = 0.034. There were no significant differences in time delays or severity of clinical symptoms for patients treated by IVT or MT, nor in the distribution of final diagnosis amongst stroke alerts and stroke unit admissions. These results suggest that the overall incidence of stroke remained the same, but fewer patients presented within the therapeutic time window. Increased public awareness and corrective measures are needed to mitigate the deleterious effects of the COVID-19 outbreak on acute stroke care.
Sections du résumé
BACKGROUND AND PURPOSE
To date, no study has attempted to quantify the impact of the COVID-19 outbreak on the incidence and treatment of acute stroke.
METHODS
This was a retrospective review of acute stroke pathway parameters in all three stroke units in the Alsace region during the first month of the outbreak (1-31 March 2020), using the similar period from 2019 as a comparator. A secondary detailed analysis of all stroke alerts and stroke unit admissions was performed in the centre with the largest case volume.
RESULTS
Compared to the same period in 2019, in March 2020 there were 39.6% fewer stroke alerts and 33.3% fewer acute revascularization treatments [40.9% less intravenous thrombolysis (IVT) and 27.6% less mechanical thrombectomy (MT)]. No marked variation was observed in the number of stroke unit admissions (-0.6%). The proportion of patients with acute revascularization treatments (IVT or MT) out of the total number of stroke unit admissions was significantly lower in March 2020 (21.3%) compared to 2019 (31.8%), P = 0.034. There were no significant differences in time delays or severity of clinical symptoms for patients treated by IVT or MT, nor in the distribution of final diagnosis amongst stroke alerts and stroke unit admissions.
CONCLUSION
These results suggest that the overall incidence of stroke remained the same, but fewer patients presented within the therapeutic time window. Increased public awareness and corrective measures are needed to mitigate the deleterious effects of the COVID-19 outbreak on acute stroke care.
Identifiants
pubmed: 32399995
doi: 10.1111/ene.14316
pmc: PMC7273043
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1783-1787Informations de copyright
© 2020 European Academy of Neurology.
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