Clinician's Perception of Practice Changes for Stroke During the COVID-19 Pandemic.
Attitude of Health Personnel
Betacoronavirus
/ pathogenicity
COVID-19
Clinical Decision-Making
Coronavirus Infections
/ diagnosis
Cross-Sectional Studies
Delivery of Health Care, Integrated
/ trends
Eligibility Determination
/ trends
Health Care Surveys
Health Knowledge, Attitudes, Practice
Host-Pathogen Interactions
Humans
Infection Control
/ trends
Occupational Exposure
/ prevention & control
Pandemics
Patient Admission
/ trends
Patient Transfer
/ trends
Personal Protective Equipment
/ trends
Pneumonia, Viral
/ diagnosis
Policy Making
Practice Patterns, Physicians'
/ trends
SARS-CoV-2
Stroke
/ diagnosis
Telemedicine
/ trends
Time Factors
United States
/ epidemiology
Acute Ischemic Stroke
COVID-19
Quality and Outcomes
Stroke management
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:
Oct 2020
Oct 2020
Historique:
received:
13
06
2020
revised:
15
07
2020
accepted:
18
07
2020
entrez:
11
9
2020
pubmed:
12
9
2020
medline:
17
9
2020
Statut:
ppublish
Résumé
Approach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey. A 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication. Respondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P = 0.047, 95% CI: 1.004-1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P = 0.052, 95% CI: 0.988-10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P = 0.023, 95% CI: 1.110-4.132). Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. There is also a reported reduction in stroke volume across hospitals. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients.
Sections du résumé
BACKGROUND
BACKGROUND
Approach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey.
METHODS
METHODS
A 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication.
RESULTS
RESULTS
Respondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P = 0.047, 95% CI: 1.004-1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P = 0.052, 95% CI: 0.988-10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P = 0.023, 95% CI: 1.110-4.132).
CONCLUSION
CONCLUSIONS
Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. There is also a reported reduction in stroke volume across hospitals. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients.
Identifiants
pubmed: 32912564
pii: S1052-3057(20)30597-8
doi: 10.1016/j.jstrokecerebrovasdis.2020.105179
pmc: PMC7375301
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
105179Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
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