Acute stroke care in a New York City comprehensive stroke center during the COVID-19 pandemic.
Aged
Aged, 80 and over
Betacoronavirus
/ pathogenicity
COVID-19
Comprehensive Health Care
/ organization & administration
Coronavirus Infections
/ diagnosis
Critical Pathways
/ organization & administration
Delivery of Health Care, Integrated
/ organization & administration
Female
Humans
Male
Middle Aged
New York City
/ epidemiology
Pandemics
Patient Care Team
/ organization & administration
Pneumonia, Viral
/ diagnosis
Quality Improvement
/ organization & administration
Quality Indicators, Health Care
/ organization & administration
Registries
Retrospective Studies
SARS-CoV-2
Stroke
/ diagnosis
Thrombectomy
Thrombolytic Therapy
Time Factors
Time-to-Treatment
/ organization & administration
Treatment Outcome
Workflow
COVID-19
Comprehensive stroke center
Quality research
Stroke
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
29
05
2020
revised:
10
06
2020
accepted:
15
06
2020
entrez:
19
8
2020
pubmed:
19
8
2020
medline:
25
8
2020
Statut:
ppublish
Résumé
The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City. We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on the quality of care for patients presenting with acute ischemic stroke (AIS). We retrospectively analyzed data from a quality improvement registry of consecutive AIS patients at New York University Langone Health's CSC between 06/01/2019-05/15/2020. During the early stages of the pandemic, the acute stroke process was modified to incorporate COVID-19 screening, testing, and other precautionary measures. We compared stroke quality metrics including treatment times and discharge outcomes of AIS patients during the pandemic (03/012020-05/152020) compared with a historical pre-pandemic group (6/1/2019-2/29/2020). A total of 754 patients (pandemic-120; pre-pandemic-634) were admitted with a principal diagnosis of AIS; 198 (26.3%) received alteplase and/or mechanical thrombectomy. Despite longer median door to head CT times (16 vs 12 minutes; p = 0.05) and a trend towards longer door to groin puncture times (79.5 vs. 71 min, p = 0.06), the time to alteplase administration (36 vs 35 min; p = 0.83), door to reperfusion times (103 vs 97 min, p = 0.18) and defect-free care (95.2% vs 94.7%; p = 0.84) were similar in the pandemic and pre-pandemic groups. Successful recanalization rates (TICI≥2b) were also similar (82.6% vs. 86.7%, p = 0.48). After adjusting for stroke severity, age and a prior history of transient ischemic attack/stroke, pandemic patients had increased discharge mortality (adjusted OR 2.90 95% CI 1.77 - 7.17, p = 0.021) CONCLUSION: Despite unprecedented demands on emergency healthcare services, early multidisciplinary efforts to adapt the acute stroke treatment process resulted in keeping the stroke quality time metrics close to pre-pandemic levels. Future studies will be needed with a larger cohort comparing discharge and long-term outcomes between pre-pandemic and pandemic AIS patients.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City. We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on the quality of care for patients presenting with acute ischemic stroke (AIS).
METHODS
METHODS
We retrospectively analyzed data from a quality improvement registry of consecutive AIS patients at New York University Langone Health's CSC between 06/01/2019-05/15/2020. During the early stages of the pandemic, the acute stroke process was modified to incorporate COVID-19 screening, testing, and other precautionary measures. We compared stroke quality metrics including treatment times and discharge outcomes of AIS patients during the pandemic (03/012020-05/152020) compared with a historical pre-pandemic group (6/1/2019-2/29/2020).
RESULTS
RESULTS
A total of 754 patients (pandemic-120; pre-pandemic-634) were admitted with a principal diagnosis of AIS; 198 (26.3%) received alteplase and/or mechanical thrombectomy. Despite longer median door to head CT times (16 vs 12 minutes; p = 0.05) and a trend towards longer door to groin puncture times (79.5 vs. 71 min, p = 0.06), the time to alteplase administration (36 vs 35 min; p = 0.83), door to reperfusion times (103 vs 97 min, p = 0.18) and defect-free care (95.2% vs 94.7%; p = 0.84) were similar in the pandemic and pre-pandemic groups. Successful recanalization rates (TICI≥2b) were also similar (82.6% vs. 86.7%, p = 0.48). After adjusting for stroke severity, age and a prior history of transient ischemic attack/stroke, pandemic patients had increased discharge mortality (adjusted OR 2.90 95% CI 1.77 - 7.17, p = 0.021) CONCLUSION: Despite unprecedented demands on emergency healthcare services, early multidisciplinary efforts to adapt the acute stroke treatment process resulted in keeping the stroke quality time metrics close to pre-pandemic levels. Future studies will be needed with a larger cohort comparing discharge and long-term outcomes between pre-pandemic and pandemic AIS patients.
Identifiants
pubmed: 32807471
pii: S1052-3057(20)30486-9
doi: 10.1016/j.jstrokecerebrovasdis.2020.105068
pmc: PMC7305900
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
105068Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None.
Références
Stroke. 2020 Jun;51(6):1896-1901
pubmed: 32347790
Neurology. 2020 Jun 16;94(24):e2608-e2614
pubmed: 32385187
Stroke. 2020 Jul;51(7):2273-2275
pubmed: 32432995
Stroke. 2020 Jul;51(7):2228-2231
pubmed: 32432998
Stroke. 2020 Aug;51(8):2540-2543
pubmed: 32466736
Stroke. 2020 Jul;51(7):2002-2011
pubmed: 32432996
J Stroke Cerebrovasc Dis. 2020 Jul;29(7):104881
pubmed: 32334918
Stroke. 2020 Jul;51(7):1991-1995
pubmed: 32438895
Stroke. 2020 Jul;51(7):1996-2001
pubmed: 32432997
Int J Stroke. 2020 Jun;15(4):385-389
pubmed: 32310015