Variability in the Transition of Care to Post-Stroke Rehabilitation During the First Wave of COVID-19.

OBJECTIVE: Evaluate transitions of acute stroke (AS) and Inpatient Rehabilitation Facility (IRF) care during the first wave of COVID-19. DESIGN: Retrospective observational study (3 Comprehensive Stroke Centers with hospital-based IRFs) between 1/1/2019-5/31/2019 (AS = 584, IRF = 210) and 1/1/2020-5/31/2020 (AS = 534, IRF = 186). AS characteristics included stroke type, demographics and medical comorbidities. The proportion of patients admitted for AS and IRF care was analyzed graphically and using t-test assuming unequal variances. RESULTS: The proportion of intracerebral hemorrhage patients (28.5 vs 20.5%, P = 0.035) and those with history of transient ischemic attack (29 vs 23.9%; P = 0.049) increased during the COVID-19 1st wave in 2020. Uninsured AS admissions decreased (7.3 vs 16.6%) while commercially insured increased (42.7 vs 33.4%, P < 0.001).AS admissions decreased from 116.5/month in 2019 to 98.8/month in 2020 (P = 0.008) with no significant difference in IRF admissions (39/month in 2019, 34.5/month in 2020; P = 0.66).In 2019, monthly changes in AS admissions coincided with IRF admissions.In 2020, AS admissions decreased 80.6% from January to February, while IRF admissions remained stable. AS admissions increased 12.8% in Mar 2020, remained stable in April, while IRF admissions decreased by 92%. CONCLUSION: Acute stroke hospitalizations significantly decreased per month during the 1st wave of COVID-19, with a delayed effect on the transition from AS to IRF care.

Comparison of Bispectral Index Monitor Data Between Standard Frontal-Temporal Position and Alternative Nasal Dorsum Position in the Intensive Care Unit: A Pilot Study.

ABSTRACT: BACKGROUND: The Bispectral (BIS) monitor is a validated, noninvasive monitor placed over the forehead to titrate sedation in patients under general anesthesia in the operating room. In the neurocritical care unit, there is limited room on the forehead because of incisions, injuries, and other monitoring devices. This is a pilot study to determine whether a BIS nasal montage correlates to the standard frontal-temporal data in this patient population. METHODS: This prospective nonandomized pilot study enrolled 10 critically ill, intubated, and sedated adult patients admitted to the neurocritical care unit. Each patient had a BIS monitor placed over the standard frontal-temporal location and over the alternative nasal dorsum with simultaneous data collected for 24 hours. RESULTS: In the frontal-temporal location, the mean (SD) BIS score was 50.9 (15.0), average minimum BIS score was 47.0 (15.0), and average maximum BIS score was 58.4 (16.7). In the nasal dorsum location, the mean BIS score was 54.8 (21.6), average minimum BIS score was 52.8 (20.9), and average maximum BIS score was 58.0 (22.2). Baseline nonparametric tests showed nonsignificant P values for all variables except for Signal Quality Index. Generalized linear model analysis demonstrated significant differences between the 2 monitor locations (P < .0001). CONCLUSION: The results of this pilot study do not support using a BIS nasal montage as an alternative for patients in the neurocritical care unit.