Effect of COVID-19 on Emergent Stroke Care: A Regional Experience.
COVID-19
Coronavirus Infections
/ complications
Humans
Indiana
/ epidemiology
Kentucky
/ epidemiology
Ohio
/ epidemiology
Pandemics
Patient Care Team
Pneumonia, Viral
/ complications
Prospective Studies
Referral and Consultation
/ statistics & numerical data
Reperfusion
Stroke
/ complications
Thrombectomy
Thrombolytic Therapy
/ statistics & numerical data
Time-to-Treatment
Treatment Outcome
pandemics
reperfusion
restaurants
stroke
viruses
Journal
Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
pubmed:
9
7
2020
medline:
10
9
2020
entrez:
9
7
2020
Statut:
ppublish
Résumé
Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities. Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year. Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%-46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%-51%), and specifically thrombolysis by 33% (95% CI, 4%-55%), but this finding had less precision. Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.
Sections du résumé
BACKGROUND AND PURPOSE
Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities.
METHODS
Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year.
RESULTS
Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%-46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%-51%), and specifically thrombolysis by 33% (95% CI, 4%-55%), but this finding had less precision.
CONCLUSIONS
Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.
Identifiants
pubmed: 32639860
doi: 10.1161/STROKEAHA.120.030499
pmc: PMC7359904
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e2111-e2114Subventions
Organisme : NINDS NIH HHS
ID : T32 NS047996
Pays : United States
Organisme : NINDS NIH HHS
ID : U24 NS107241
Pays : United States
Références
Interv Neuroradiol. 2019 Dec;25(6):613-618
pubmed: 31248312
JAMA Intern Med. 2020 Jul 1;180(7):934-943
pubmed: 32167524
J Am Coll Cardiol. 2020 May 12;75(18):2352-2371
pubmed: 32201335
Thromb Res. 2020 Jul;191:145-147
pubmed: 32291094