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Introduction: IslaCare is a digital platform that allows patients and clinicians to capture, store and securely share images, videos, voice notes and assessments. It facilitates decision making and is approved by NHS digital. COVID- 19 challenged services which demanded innovation in Stroke rehabilitation. Challenges included reduced in-reach access into acute services, orthotics, spasticity clinic, reduced access into care homes and patient's homes through fear of active COVID outbreaks and subsequent impacts on service delivery. IslaCare offered a solution, enabling the team to evidence clinical effectiveness and progress, inform clinical conclusions, facilitate patient in-reach processes and visually support remote assessment and monitoring. Method(s): IslaCare was initially piloted in Community Stroke Team for 12 weeks. Training was provided prior to launch. Secondary engagement with Nottingham University Hospitals NHS Trust (NUH) stroke unit commenced during the pilot period which involved the mobilisation of IslaCare at NUH. Feedback was gained from both clinicians and patients to understand the impact on clinical care and patient experience. Result(s): 63 patients have been included to date. 341 videos or photo submissions to IslaCare. 70% patient response rate. 80% staff agreed/ strongly agreed that IslaCare added value to the assessment process. 100% patients surveyed reported feeling connected with their care. Conclusion(s): IslaCare was easily rolled out across the stroke pathway and embedded into clinical practice. This enhanced effective handover of patients, improved triage and discharge planning. It has enriched patient records, measurement of progress, improved efficiency, reduced waits and chaperone input in clinic settings whilst also increasing quality of care.
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Introduction: Research shows patients having in-patient rehabilitation spend most of their day inactive with few opportunities for social interaction. Evidence suggests the physical environment impacts on well-being during rehabilitation. On the acute stroke unit, at St Georges Hospital, social spaces available for patients were repurposed for clinical use during the COVID pandemic. This project aimed to collaborate with patients, families and staff to enhance the ward environment. Method(s): CREATE, a co-designed, collaborative project model aiming to increase patient activity on stroke units, was adopted. Questionnaires were distributed to patients, families and staff on their views of the current use of the ward spaces with suggestions for change. Charitable funds were contacted to gain advice around provision of resources and funding. Result(s): Results indicated a lack of communal spaces for socialising and a need for more organised activities. Two strands of focus were agreed: 1. Revitalisation of communal spaces;2. Establishing a permanent activities coordinator. The project is now in the implementation phase. Conclusion(s): This quality improvement project sought to understand the views of patients, families and staff on how the physical ward environment was utilised and the interplay with their rehabilitation experience. Findings suggested the need to reclaim and revitalise social spaces on the ward and to establish a permanent activities coordinator role. The creation of a less institutional and more welcoming environment will better support patients' sense of well-being during rehabilitation. Success will lead to an increase in participation in social interaction for patients outside of therapy time.
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Background and aims: Hospitals around the world introduced considerable visitation restrictions to reduce the risk of infection during epidemic spread of SARS-CoV2. Understanding the negative impacts of visitation restrictions on subgroups of patients may help to balance and adjust policies accordingly or introduce further measures to mitigate their impact. Patients with acute cerebrovascular disease are at high risk of delirium. Lack of family visitation is discussed as a risk factor for development of delirium. We aimed to investigate the association of visitation restrictions with delirium incidence in patients with acute cerebrovascular disease treated in a stroke-unit. Method(s): Data from all stroke-unit cases with transient ischemic attack or stroke (ischemic/hemorrhagic) admitted between January 2017 and November 2021 to an over-regional university hospital stroke center were compared between three groups depending on visitation policy implemented at time of admission: pandemic-associated absolute visitation restriction (no visitors unless medical reasons or in palliative settings;n = 1087), limited visitation policy (one visitor per patient for one hour per day between 3 and 6 pm;n = 862) and pre-pandemic visitation policy (two visitors per patient at any time between 2.30 and -6.30 pm + 10 and -12 am on weekends;n = 3830). ICD-10 diagnosis of delirium and potentially relevant confounders were extracted (age, sex, acute infection (pneumonia, urinary tract infection, sepsis), SARS-CoV2 status (regardless of symptoms), history of dementia and duration of hospital stay). Univariate comparison and multiple logistic regression analyses were conducted to evaluate association of delirium with visitation restrictions. Result(s): 5779 cases were included in our analysis (median age 75 years [IQR: 64-83], 45.5% female). We observed delirium incidences of 6.3% during pandemic-associated absolute visitation restriction, 5.8% with limited visitation policy and 5.1% with pre-pandemic visitation policy (p = 0.239). In multiple logistic regression analyses adjusting for clinically relevant variables, we found any pandemic-associated visitation restriction (OR: 1.353, 95%CI: 1.059-1.730, p = 0.016) and, differentiating between scope of visitation restriction, specifically absolute visitation restriction (OR: 1.351, 95%CI: 1.005-1.817, p = 0.046) independently associated with delirium. Other factors associated with delirium were older age (OR:1.051, 95%CI: 1.039-1.064, p < 0.001), male sex (OR: 2.197, 95%CI: 1.705-2.831, p < 0.001), stroke versus TIA (OR: 1.886, 95%CI: 1.209-2.943, p = 0.005), acute infection (OR: 2.111, 95%CI: 1.624-2.743, p < 0.001), history of dementia (OR: 1.787, 95%CI: 1.221-2.615, p = 0.003) and longer duration of hospitalization (OR: 2.988, 95%CI: 2.281-3.914, p < 0.001). Positive SARS-CoV2-PCR status did not significantly predict delirium in our cohort. Conclusion(s): Pandemic-associated visitation restrictions and specifically absolute visitation restrictions were found to be associated with a higher incidence of delirium among stroke-unit patients with acute cerebrovascular disease. Benefit and harm of visitation restrictions even bevond the current pandemic should be carefully weighed and adjusted for patients otherwise at increased risk for delirium.Copyright © 2023
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Introduction: This multi-professional programme was developed by the stroke team at Chelsea and Westminster Hospital (CWH) to support stroke survivors post discharge into the community. Approximately one third of patients have significant impairments post stroke;physical, cognitive, visual, or speech/language related. Most patients and carers suffer a period of adjustment post discharge. The psychological aspect of stroke can have a huge impact beyond the inpatient setting. Method(s): The programme aims to: - Provide a platform where patients and relatives can meet the stroke team, giving them opportunity to become more informed of their own experience and highlight on-going needs. - Strengthen alliances with community and voluntary services. - Empower patients to seek self-management strategies to monitor and progress their long-term condition. - Sign-post stroke survivors to community stroke help groups and charities. - Increase high quality rehabilitation in-line with the NHS Longterm Plan. - Build a network of stroke survivors that support each other during their recovery. Result(s): The programme was planned face-to-face yet due to the Covid Pandemic, our first session ran virtually on 20/09/21, followed by 4 sessions every 2 months. Further sessions will hopefully be face-to-face. Conclusion(s): Feedback from stroke survivor attendees has been extremely positive (100% recommend it). We presented our innovative programme at a Dragon's Den style Trust event in November 2021. Feedback was very complimentary and we were privileged enough to receive a 10,000 Grant funded by NHS England and CWH Charity. This Grant will go towards development of the programme, support our stroke unit and nurse training.
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Introduction: Effective multidisciplinary team working enhances patient care and staff performance and reduces length of stay. In stroke services, this has recently been strained by challenges of staff shortages, team exhaustion and COVID-19, in addition to SSNAP data reporting responsibilities. Consequently, psychological distress has heightened in these healthcare workers. Understanding staff experiences in stroke team environments is crucial to staff retention, wellbeing, and reshaping effective multidisciplinary processes. Method(s): Clinical staff in emergency, hyperacute, and acute stroke units at our hospital were invited in May 2022 to complete an online questionnaire based on validated measures of teamwork, stress, and burnout. Result(s): Twenty-seven respondents represented across therapy, medical (29.6%), and nursing (29.6%) teams. Teamworking was rated as positive by most staff (63%), relating this to open communication and diverse, specialised stroke knowledge. Over 75% of the sample experienced moderate to high burnout, with prevalent experiences of emotional exhaustion. External pressures to meet SSNAP requirements was a time resource barrier that lowered sense of both personal achievement and input into directing work duties. Stress was in the severe-dangerous range for 37% of respondents. Key themes identified for improvement were opportunities for education and service development, and efficiency of knowledge sharing. Conclusion(s): Our multidisciplinary stroke teams reported high levels of stress and burnout, associated with challenging staff to patient ratios, and feeling professional autonomy is compromised to meet stroke service standards. Positive experiences of teamworking were viewed as partially protective against further distress escalations. Results highlight the critical need for novel implementations focusing on team support and development.
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Introduction: EMGT is an effective, evidence based intervention for improving mobility outcomes in people with stroke. It enables highly repetitive stepping practice, in patients who are unable to stand/step. Despite being recommended in national guidance, adoption within the UK is extremely limited. We report preliminary data from its implementation in an NHS stroke service. Method(s): We initiated use of EMGT in our Acute Stroke Unit in November 2021 - implementation has been phased, and use was limited at times due to the COVID-19 pandemic. Patient demographics, clinical outcome measures and discharge information are recorded pre- and post-treatment. Result(s): To date, 38 patients have used EMGT, accumulating 232 sessions of walking. 74% of patients were male. . Mean age was 73.5 years (range 51 - 91). 19 patients used EMGT for >=3 sessions;of those, 14 completed > 6 sessions. Median Functional Ambulatory Category (FAC) at baseline was 0 (range 0-1), rising post treatment to 2 (range 0-4). Mean modified Rivermead Mobility Index rose from 13.5 to 24.3. 57% of patients who used EMGT as part of their rehabilitation programme were able to mobilise at least 10 metres post intervention. Initially, only 1 patient could manage a step transfer and following treatment this increased to 8. Conclusion(s): Early results indicate that EMGT is feasible in an acute NHS setting, alongside conventional care. It enables early and highly intensive mobilisation, resulting in improved function. Further work is required to develop clinical protocols, establishing recommended dose, time after stroke for EMGT initiation, and recommended duration of treatment.
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Introduction: The nursing workforce across stroke services is integral to the delivery of specialist stroke care Despite this, nursing interventions and patient contact time are not captured via the SSNAP audit as other disciplines are, resulting in the stroke nursing workforce being influenced by local priorities with poor provision largely unrecognised. Furthermore, staffing constraints caused by covid 19 has resulted in the redeployment of specialist nurses, directly impacting the immediate provision of stroke care and depriving stroke units of clinical expertise. Method(s): Quantitative and qualitative methods were applied. This included data relating to nursing establishments, vacancies, bed configurations, electronic rostering systems and the safer nursing care tool. This information was supported by written evidence from senior stroke nursing leads. Analysis of fifteen acute stroke services was completed. Result(s): A detailed regional report was compiled and shared system wide. Each provider was presented with an individual analysis. Over 60 key findings and 19 recommendations covering four main themes were established including: Establishments against national guidance unrealised. HASUs staffed against Safecare sitting below RCP recommendations HASU beds are not recognised on electronic rosters leading to general ward theories being applied. Significant movement of band 5 nurses affecting retention. HASU beds poorly aligned with significant variations of admissions per bed. Specialist nursing team management influencing SSNAP attainment. Conclusion(s): Poor understanding of stroke nursing requirements is evident regionwide. The use of healthroster and safecare tools in stroke units is inappropriately utilised and poorly understood. There is a direct correlation between specialist nurse organisation and SSNAP achievement.
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Introduction: The SSNAP stroke unit domain audit results have declined during the covid-19 pandemic. As recovery plans are implemented regionally, this study aims to understand the barriers to rapid admission to stroke speciality beds. Findings will inform quality improvement opportunities and change. Method(s): A mixed method approach was applied. Details pertaining to all patients that breached the four hour standard were collected across fourteen acute services for two months. This included all patients that were following the stroke pathway irrespective of final diagnosis. Additionally, details of all protocols pertinent to this KPI were established to identify effectiveness of local policy. The bed management was investigated for efficacy (stroke teams verses other) and differences in and out of hours explored. Covid as a direct cause was examined. Result(s): Analysis continues, however preliminary regional and team centred reports are collated. Eleven policies were examined. A negative association was identified between policies in place and admissions within four hours. A positive correlation existed between stroke team management of speciality beds and timely admissions, however, 67% of SU's were managed by other teams. 20% of breaches were multifactorial. Four covid related causes were detected. More breaches occurred in hours. The day of the week had no direct association with admission delay. Robust management of medical outliers is fundamental. Conclusion(s): Initial findings do not support assumptions. SU beds are not well managed well despite policies in place to support this. Breaches to stroke unit admissions is multifactorial but the failure to safeguard stroke speciality beds is key.
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Introduction: Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current penand- paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Method(s): Patients were approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have pre-existing medical condition i.e dementia, severe aphasia or too medically unwell to complete the assessment. Participants completed the computerised doctor or "CognoSpeak" on the ward using a tablet or at home via a web-version (on home computer or tablet). The assessment included the GAD and PHQ9. All had standard cognitive assessment done with the Montreal Cognitive Assessment (MOCA). Result(s): Recruitment started on 8th December 2020 and is on-going. 951 people were screened and 104 were recruited. 49 have completed baseline Cognospeak, 8 have withdrawn and 3 have died. The mean NIHSS was 3.8 and mean MoCA of 23.9, 31 were female. Participants had a mean education level of 17 years. Conclusion(s): Preliminary data will be presented highlighting feasibility of an automated cognitive and mood assessment that can be completed at home and on the Hyper-acute Stroke Unit. Screening was adapted due to Covid pandemic and utilising remote consent and participation allowed the project to continue.
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Introduction: Stroke units have remarkably reduced morbidity and mortality in patients by bringing together a multidisciplinary team that aids in quick stroke diagnosis, emergency treatment, restoration of homeostasis, prevention of common complications, rehabilitation and secondary prevention. Our audit looks at factors that cause delay in early transfer of patients from emergency department to HASU (hyper-acute stroke unit) and aims to find solutions to reduce transfer time. Method(s): We obtained our data from stroke database maintained by hospital's medical records department. All patients presenting with acute stroke (ischemic and hemorrhagic) during the month of November and December2021 and fulfilling our inclusion criteria were evaluated. Result(s): A total of 138 patients presented to our stroke-care facility in the two months period with 79 eligible for stroke unit admission, out of which 52 (65.8%) were females and 27(34.2%) were males. The mean door to stroke unit time in our study was 278.6 minutes with major delays beyond 4hours caused by non-availability of beds(32.0%), covidrelated issues(25.5%),monetary issues(17.0%) initial referral delays(14.9%) and imaging delays(10.6%) respectively. Conclusion(s): Our audit showed that most of the delays were infrastructure- related like lesser stroke dedicated beds, separate facility for covidaffected stroke patients and no designated Ct scanner/ stroke nurse for acute stroke patients assessment in triage. Additional cause identified was low socioeconomic status hampering affordability of acute stroke care.
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Introduction: During the Covid-19 pandemic it was recognised by MTW, a reconfiguration of the acute hospital would be required to create extra bed capacity and protect vulnerable patient groups. Alongside the pandemic the Kent and Medway stroke reconfiguration occurred (Winidbank, 2015). Since July 2020, MTW Stroke Unit admission data shows an average rise of 107% in activity. In December 2020, 'The Hilton Stroke Pathway' (HSP) was developed as a 6 month rehabilitation pilot to increase the MTW bed-base away from the acute site . The pathway consisted of an innovative virtual and homecare rehabilitation service in collaboration with Hilton Nursing Partners. Method(s): The pilots were evaluated using 5 key criteria: financial performance, clinical service delivery, quality of care, patient experience and stakeholder feedback. The pathway is overseen by MTW therapists, discharge liaison services and Hilton care. The aim of the pathway: Enable safe discharge home for stroke patients requiring specialist rehabilitation as soon as they were medically fit. Ensure patients rehabilitation was delivered safely and effectively. Provide a flexible service supporting patients with a range of therapy need. Provide nursing and care support as required. There are 3 levels of support: recovery, moderate and intensive. The MDT discussed which level was most appropriate for the patient. This was then reviewed as patients improved. Initially the therapy was overseen virtually by the OT, PT and SALT team. However, due to complexity of some of the patients' rehabilitation needs, therapy staff shifted to face-to-face therapy sessions. Due to the success of the pilot phase MTW decided to transition the pathway to business as usual. As part of this the pathway was reviewed in collaboration with KCFHT and therapy outcome measures were collected. Monthly monitoring meetings continue with Hilton, to ensure ongoing quality of care and effectiveness of the pathway Results: Since the beginning of the pilot the pathway has achieved positive results in SSNAP. Between January and June 2021 92.2% required OT, 84.4% required PT and 63.3% required SALT. The results in chart 1-2 are from Jan - April 2022. Chart 1 shows patient outcomes for destination on discharge. Chart 2 shows the difference in Therapy Outcome Measure (TOMs) admission and discharge scores. There has been a significant difference in the TOMS in three domains (significant difference=0.5)(Enderby and John, 2019), impairments, activity and participation. The biggest improvements has been seen in activity and participation meaning the HSP are enabling patients to integrate back into society and their occupational roles in life. The pilot evidenced using multi-organisational working has enabled earlier and safer discharges home. The new pathway has allowed for flexible acute bed capacity following the closure of stroke services at Medway hospital and during the challenges that accompanied the Covid-19 pandemic. The HSP has shown significant improvement with functional outcomes and integration back into occupational roles. In 2022 52% of the patients did not require further social care at the end of the pathway. SSNAP data shows a higher intensity of therapy was provided with an average of 34 minutes of OT, 37 minute of PT and 14 mins of SALT per day, whilst on the pathway. Therefore, MTW and Hilton Nursing Partners are keen for continuation of this pathway into future stroke development. Additionally, collaboration with KCHFT community neurorehabiliation team enabled the West Kent stroke rehabilitation pathways to be defined seen in Chart 3. The integration of Hilton Nursing Partners and the MTW MDT enabled safe and effective facilitation for stroke patients into their homes, whilst achieving high levels of independence. Conclusion(s): The stroke service demonstrated what can be achieved in a short timeframe and in challenging circumstances. The implementation was robust and a positive use of NHS resources to proactively enable changes in stroke service provision required across West Kent The pathway was well received by patients and staff, providing a direction of travel towards community-based stroke rehabilitation services which reflect the national guidelines for stroke services (RCP, 2016;NICE, 2013).
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Introduction: Cerebral venous sinus thrombosIs (CVST) is a rare condition compared to other categories encountered in stroke medicine.It occurs more frequently in patients with conditions that predispose them to other venous thrombosis, such as thrombophilias, acute malignancies, nephrotic syndrome, and COVID-19. CVST was identified as one of the rare causative of stroke. The exact mechanism of the stroke is not fully understood. However, a commonly agreed pathophysiology is that a dysfunction in arachnoid granulation can lead to sinus occlusion. Subsequently, this leads to a reduction in cerebral fluid drainage, which can increase intracranial pressure, causing capillary hypertension, cerebral oedema, decrease in cerebral perfusion pressure and venous haemorrhage. The European Stroke Organisation (ESO) supports using both MRI/MR Venogram and CT venogram as modalities for diagnosis of CVST, with no particular preference of one over the other. The standard practice in the management of cerebral venous sinus thrombosis includes treating the clot and its precipitating factors and treating the sequela of the clot as in the case we are reporting. Yet, there is no clinical guideline for the more aggressive measures to break down the clot in either AHA or European Stroke Organization, but they are used in clinical practice, with promising results in certain cases. Our case is an example of a successful mechanical thrombectomy with a lifesaving outcome. Method(s): We are reporting an unusual case of a 27- year- old lady who presented to the hyperacute stroke unit with dense right- sided weakness and expressive dysphasia. After an initial CT (Computerised Tomography) scan confirming extensive cerebral venous sinus thrombosis, she went for urgent mechanical thrombectomy. The clinical assessment after the procedure showed significant recovery in power of the right limbs and speech. She was discharged 7 days later with near full recovery. Venous thrombectomy is a rarely performed procedure. However, in this case, it was potentially lifesaving and resulted in an excellent clinical outcome. Result(s): An MRI/MRV follow up in a month demonstrated that the lesion on left centrum semiovale had regressed compared to the first scan. Also, there was some evidence of recanalization of her transverse sinuses. She was assessed by the therapist two months from the event. The patient reported some word finding difficulties and clumsiness in the right hand and leg. However, no further major event since her thrombectomy, and now aiming to get back to work. Conclusion(s): Mechanical thrombectomy in cerebral venous sinus thrombosis can be an effective, life-saving, and safe procedure with an extremely rewarding outcome. It should be considered in patients with acute neurological deterioration despite anticoagulant therapy.
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INTRODUCTION: Hospitals around the world introduced considerable visitation restrictions to reduce risk of infection during epidemic spread of SARS-CoV2. Understanding of negative impacts of visitation restrictions on subgroups of patients may help to balance and adjust policies accordingly or introduce further measures to mitigate their impact. We aimed to investigate the association of visitation restrictions with delirium incidence in stroke-unit patients. METHODS: In a non-randomized observational design, data from 5,779 stroke-unit cases with transient ischemic attack or stroke (ischemic/hemorrhagic) admitted between January 2017 and November 2021 were compared between three groups depending on visitation policy implemented at time of admission: pandemic-associated absolute visitation restriction (n = 1,087), limited visitation policy (n = 862), and pre-pandemic visitation policy (n = 3,830). Univariate comparison and multiple logistic regression analyses were conducted to evaluate the association of delirium with visitation restrictions. RESULTS: We observed delirium incidences of 6.3% during pandemic-associated absolute visitation restriction, 5.8% with limited visitation policy, and 5.1% with pre-pandemic visitation policy (p = 0.239). In multiple logistic regression analyses adjusting for clinically relevant variables, we found the presence of any pandemic-associated visitation restriction (odds ratio [OR] 1.363, 95% confidence interval [CI]: 1.066-1.744, p = 0.014) and specifically absolute visitation restriction (OR 1.368, 95% CI: 1.016-1.843, p = 0.039) independently associated with delirium in patients with acute cerebrovascular disease. Other factors independently associated with delirium were older age, male sex, stroke versus transient ischemic attack, acute infection, history of dementia, and longer duration of hospital stay. CONCLUSION: Pandemic-associated visitation restrictions and specifically absolute visitation restrictions are associated with a higher incidence of delirium among stroke-unit patients with acute cerebrovascular disease. Benefit and harm of visitation restrictions should be carefully weighed and adjustments considered for patients otherwise at increased risk for delirium.
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Background: A growing body of international research suggests the prevalence of upper limb weakness early after stroke is currently lower (40-57%) than widely cited values of 70-80% from two decades ago. Recent work also indicates the distribution of upper limb weakness may be bimodal, with a higher proportion of people with severe or little/no weakness as compared to mild/moderate weakness. Aim: To describe the prevalence and distribution of upper limb weakness early post-stroke. Methods: Patients admitted to a tertiary acute stroke unit with a suspected stroke were screened between November 2018 to February 2020 (interrupted by COVID-19) and April to November 2021. Upper limb weakness was captured via Shoulder Abduction and Finger Extension (SAFE) score (0-10), which was prospectively assessed at first contact by the unit therapist. Data on stroke type, acute medical intervention received, and National Institute of Health Stroke Scale (NIHSS) were also extracted. Results: A total of 662 individuals with confirmed stroke (median NIHSS score 6, IQR 2-13) were administered SAFE a median 1 (IQR 1,2) day after unit admission. Only 46.2% had upper limb weakness (SAFE score ≤9). Three most common SAFE scores were 10 (53.8%), 8 (11.5%) and 0 (9.4%). The subgroup severity distribution was 59.2% little to no impairment (SAFE 9-10), 24.1% mild to moderate impairment (SAFE 5-8), and 16.7% severe impairment (SAFE 0-4). Approximately one third (29.8%) received ≥1 acute interventions (e.g., thrombolysis, thrombectomy). Data collection remains ongoing, and a larger total sample will be presented. Conclusion: The prevalence of upper limb weakness at this single tertiary centre aligns with recent international data. A better understanding of the upper limb weakness profile will help inform service delivery e.g., shifting resources to subgroups which are more common. Furthermore, it can guide researchers in target population selection in trials, which can enhance generalisability of findings.
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Background and aims: Vaccination against SARS-CoV-2 has been associated with rare occurrences of cerebral venous thromboses. Very little data exist about arterial ischemic strokes. We have assessed the features of ischemic strokes occurring shortly after vaccination against SARS-CoV-2 in the Cremona area, Italy. Methods: From February 1, to July 31, 2021, all patients with ischemic stroke within four weeks of vaccination against COVID-19 admitted to our stroke unit were consecutively collected, and their main features were compared with those of all other patients with ischemic strokes admitted during the same period. Results: Sixteen strokes shortly after vaccination were collected. They represented 10.5% of all ischemic strokes. Median interval from vaccination was 12 days (range 1-24). Fifteen (93.8%) had received the BNT162b2 (Pfizer-BioNTech) vaccine and 1 (6.2%) the ChAdOx1 nCoV- 19 (AstraZeneca). Two patients (12.5%) had mild thrombocytopenia on admission (128,000 and 142,000/ml), without any evidence of bleeding or venous thrombosis. Thrombolysis and/or thrombectomy were carried out in 4 cases (25.0%). When compared with 137 strokes without recent vaccination, none of the demographic, clinical, and laboratory features of post-vaccination strokes were significantly different. Conclusions: This is the largest description of ischemic strokes shortly after COVID-19 vaccination. Strokes features were mostly similar to those of other stroke patients. Thus, the relatively high percentage of such patients probably relates to the very high fraction of elderly people vaccinated against SARS-CoV-2 in the Cremona area, rather than to a consequence of vaccination. These data may also be useful to counsel patients about future vaccinations.
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Background and aims: RES-Q Registry is the first stroke database in Romania. The aim is to map key performance indicators for quality of stroke care and to improve stroke management Methods: Each center registers all stroke patients hospitalized in march, yearly. Results: The number of participated centers has increased from 10 in 2017 to 36 in 2021. In five years we have registered 8467 patients. The median age was 71.46 years, median NIHSS at admittance 7.8 points, 82.8% ischemic strokes. Despite improvement in revascularization procedures (intravenous thrombolysis increased from 2.27% in 2017 to 10.56 in 2021, and mechanical thrombectomy from 0,1% to 1,7%) median Modified Rankin Score at discharge did not change significantly and mortality has increased (from 15.09% in 2017 to 19.03% in 2021). A reason for increased mortality is due to Covid-19 pandemic (poor access to primary care, more severely ill, increased door to needle time due to epidemiologic circuits), but beside this, there are unsolved problems, such as the very low percentage (below 1%) of decompressive hemicraniectomy, the reduced capacity to actively detect atrial fibrillation ( 36.9% of patients are still screened for AF only by repeated ECG), the low percentage of carotid imaging (56.7%) and revascularization procedures (less than 7% of symptomatic carotid stenosis). Conclusion: For a better prognosis of stroke we need to increase the number of properly financed stroke units, the educational activities, and to elaborate and implement a national stroke plan.
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Background: Acute stroke unit care is proven to reduce mortality and morbidity. During the COVID-19 crisis, we must guarantee the provision of acute stroke care and optimize care protocols to reduce the risk of SARS-CoV-2 infection and rationalize the use of hospital resources. Our hospital developed an adapted protocol which includes individual isolation room equipped with a monitor connected to the central monitoring unit of the stroke unit, and a camera that allowed patient supervision from the control nursing unit for stroke patients with suspected or confirmed COVID-19 infection. We present a descriptive study of our experience. Methods: Observational, extensive, and transversal study. Patients admitted to the monitored isolation room of our stroke unit between November-2020 to december-2021. Results: 201 patients, 51,7.% women. 76.1% ischemic stroke, of which 10% had been treated with thrombolysis and 2.9% with thrombectomy. 90.3% without infectious symptoms. In 6.2% the Covid infection was known before their arrival at the emergency room, in 3 patient it was detected in the emergency room and in 4 during their stay in the isolation room. No contagions were detected within the stroke unit after the introduction of this measure. Only 10,1% of the patients stayed in the room for more than 24 hours. Camera detect care needs in 22% of the patients. The destination at discharge was conventional stroke unit in 83.4% of the patients. Conclusions: an isolation room monitored and controlled by video surveillance is an effective alternative to prevent infections in the stroke unit.
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Background and aims: To observe how the Covid-19 pandemic affected trends in referrals to our tertiary hyperacute stroke unit (HASU). Methods: Referrals from emergency departments in hospitals within our sector were made electronically using the online 'Refer-A-Patient' system. We reviewed 150 referrals made post-Covid, from 16th March 2020 (when Covid restrictions were first introduced in the UK) until June 2020. These were compared with 150 referrals made pre-Covid, between March and June in 2019. Results: The patients in the pre-Covid referral cohort were significantly older on average than the post-Covid referral cohort (p=0.0476);there were more referrals under the age of 50, and fewer over the age of 80, post-Covid. We accepted significantly fewer patients for transfer post-Covid compared with pre-Covid (21% vs. 43% respectively, p=0.0001). The percentage of cases with a confirmed stroke diagnosis post-transfer was marginally higher post-Covid than pre-Covid (69% vs. 59% respectively, p=0.2443). Importantly, of the patients not accepted for transfer post-Covid, none had a subsequent stroke diagnosis. Conclusions: The Covid-19 pandemic seems to have led to a more selective approach in accepting referrals for transfer. This in turn appears to have reduced our stroke mimic rate. This poses an argument that there are benefits in being more selective. Video triage is an emerging tool, which can be used in emergency departments to aid the accuracy of selection for transfer and warrants further evaluation.
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Background and aims: Clinicians and researchers have addressed concerns about the negative impact of COVID-19 outbreaks on the ability of health care systems to provide timely assessment and acute therapies to patients with stroke. The aims of this study are to describe stroke care during the first wave of the COVID-19 pandemic compared to the same period the year before at a large acute care hospital in Sweden. Methods: In this cohort study data were collected from March 1st to August 31st in 2019 and 2020 on all patients diagnosed with stroke and TIA and registered at Danderyd Hospital in the national quality registry (Riksstroke). Data were completed with information from the medical record. Sweden had no lockdown during 2020. The number of patients with COVID-19 the same period 2020 treated at Danderyd Hospital were collected. Results: In year 2019 there were 472 registered stroke patients at Danderyd Hospital, compared to 481 registered stroke patients the same period during 2020. The number of minor stroke and TIA during the period in 2019 compared to 2020 were 424 versus 410 respectively (-3.3%). During the study period 2020 1428 patients with a COVID-19 diagnosis were treated. There was an increased delay from onset to arrival to the ED and door-to needle time. The rate of admission to Stroke Unit care and the rate of thrombolysis was maintained. Conclusions: There were no difference in the number of patients diagnosed with stroke and TIA during the first wave of the COVID-19 pandemic.
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Background: The COVID-19 pandemic has been reported as affecting the quality and outcomes of stroke care around the world. The impact of the first and second waves of the pandemic in the UK are compared. Methods: Data were extracted from the Sentinel Stroke National Audit Programme database of stroke admissions in England, Wales and Northern Ireland. Care quality and outcomes for 72,698 patients admitted during the first (1 March - 30 June 2020) and second (27 September 2020 - 31 March 2021) pandemic waves were compared. Results: From the first to second wave, there was an increase in mild strokes admitted (40.3% to 41.3%;p=0.002) and median NIHSS on arrival decreased (5 vs 4, p<0.001). The second wave was characterised by a decrease in direct stroke unit admission (79.8% to 76.6% ;p<0.001). Time to initial assessment by all specialists increased. Time to stroke consultant assessment increased by 34 minutes (262 vs 296 minutes;p<0.001). Complications (pneumonia: 8.6% to 9.4%, UTI: 3.3% to 3.9%;both p < 0.001) and in-hospital mortality (10.6% to 12.4%;p<0.001) increased significantly. Moderate and moderately-severe disability were more prevalent at discharge (18.1 to 18.6%, 18.3% to 19.9% respectively;p<0.001). Early supported discharge increased from 39.1% to 44.5% (p>0.001). Conclusions: Hospital avoidance by patients with mild stroke seen in the first wave was not replicated in the second wave. COVID-19 pressures on hospitals in the second wave appeared to result in fewer direct stroke unit admissions, delays in acute assessment, more complications, and more in-hospital deaths. (Figure Presented).