ABSTRACT
Resumen Introducción La pandemia secundaria a COVID-19 modificó de forma sustancial el funcionamiento habitual de los sistemas de salud en el mundo, impulsando, entre otros problemas, retrasos en la atención de pacientes con enfermedades agudas como el accidente cerebrovascular (ACV). Analizamos las particularidades de nuestra población con ACV agudo antes y durante la pandemia. Materiales y métodos Cohorte prospectiva de pacientes adultos ingresados al Hospital Británico de Buenos Aires por ACV isquémico entre el 20 de marzo de 2020 y el 20 de marzo de 2021, que se comparó con los pacientes internados en el mismo intervalo de tiempo durante el año anterior. Resultados De 121 pacientes, el 51,2% (n=62) fueron varones y el promedio de edad fue de 70,4 años (DE 19,9). Se realizó hisopado nasofaríngeo COVID en 104 (85,6%) pacientes, resultando positivo en 11 de ellos (9,1%);en 4 de ellos el ACV fue la manifestación inicial de la COVID. El ACV de causa indeterminada fue más frecuente durante la pandemia (p<0,05), hubo una disminución del 21% en el número total de consultas por ACV isquémico y un retraso de 4h (RIC 0-2,5) en el periodo de ventana durante la pandemia. Conclusión La pandemia impacta de manera negativa en la evaluación de los pacientes con ACV. Los futuros cambios en la atención extra e intrahospitalaria y la información hacia los pacientes deben continuar para evitar retrasos en la asistencia, aun cuando las miradas se centren en los pacientes infectados por COVID-19. Introduction The COVID-19 pandemic substantially modified the normal functioning of health systems in the world, promoting, among other problems, delays in the care of patients with acute diseases such as stroke. We analyze the particularities of our population with acute stroke before and during the pandemic. Materials and methods Prospective cohort of adult patients admitted to the British Hospital of Buenos Aires for ischemic stroke between March 20, 2020 and March 20, 2021 and compared with patients admitted in the same time interval during the previous year. Results One hundred and twenty-one patients were included;the 51.2% (n=62) were male and the average age was 70.4 years (SD 19.9). COVID nasopharyngeal swab was performed in 104 (85.6%) patients, resulting positive in 11 of them (9.1%);in 4 patients, stroke was the first manifestation of the COVID infection. Stroke of undetermined cause was more frequent during the pandemic (P<.05), there was a 21% decrease in the total number of consultations for ischemic stroke and a 4-h delay (IQR 0-2.5) in the window period during pandemic. Conclusion The pandemic has a negative impact on the evaluation of stroke patients. Future changes in outpatient and inpatient care and patient information must continue to avoid delays in care, even as all eyes are focused on patients infected with COVID 19.
ABSTRACT
OBJECTIVES: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially during peak periods. We assessed the impact of the pandemic and lockdowns in stroke admissions and care in Latin America. MATERIALS AND METHODS: A multinational study (7 countries, 18 centers) of patients admitted during the pandemic outbreak (March-June 2020). Comparisons were made with the same period in 2019. Numbers of cases, stroke etiology and severity, acute care and hospitalization outcomes were assessed. RESULTS: Most countries reported mild decreases in stroke admissions compared to the same period of 2019 (1187 vs. 1166, p = 0.03). Among stroke subtypes, there was a reduction in ischemic strokes (IS) admissions (78.3% vs. 73.9%, p = 0.01) compared with 2019, especially in IS with NIHSS 0-5 (50.1% vs. 44.9%, p = 0.03). A substantial increase in the proportion of stroke admissions beyond 48 h from symptoms onset was observed (13.8% vs. 20.5%, p < 0.001). Nevertheless, no differences in total reperfusion treatment rates were observed, with similar door-to-needle, door-to-CT, and door-to-groin times in both periods. Other stroke outcomes, as all-type mortality during hospitalization (4.9% vs. 9.7%, p < 0.001), length of stay (IQR 1-5 days vs. 0-9 days, p < 0.001), and likelihood to be discharged home (91.6% vs. 83.0%, p < 0.001), were compromised during COVID-19 lockdown period. CONCLUSIONS: In this Latin America survey, there was a mild decrease in admissions of IS during the COVID-19 lockdown period, with a significant delay in time to consultations and worse hospitalization outcomes.