Acute stroke care in a New York City comprehensive stroke center during the COVID-19 pandemic.
J Stroke Cerebrovasc Dis
; 29(9): 105068, 2020 Sep.
Article
in English
| MEDLINE | ID: covidwho-609439
ABSTRACT
BACKGROUND AND PURPOSE:
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:
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:
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, pâ¯=â¯0.06), the time to alteplase administration (36 vs 35 min; pâ¯=â¯0.83), door to reperfusion times (103 vs 97 min, pâ¯=â¯0.18) and defect-free care (95.2% vs 94.7%; pâ¯=â¯0.84) were similar in the pandemic and pre-pandemic groups. Successful recanalization rates (TICI≥2b) were also similar (82.6% vs. 86.7%, pâ¯=â¯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, pâ¯=â¯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.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pneumonia, Viral
/
Thrombolytic Therapy
/
Thrombectomy
/
Coronavirus Infections
/
Comprehensive Health Care
/
Delivery of Health Care, Integrated
/
Quality Indicators, Health Care
/
Stroke
/
Quality Improvement
/
Betacoronavirus
Type of study:
Cohort study
/
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Qualitative research
/
Randomized controlled trials
Topics:
Long Covid
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
North America
Language:
English
Journal:
J Stroke Cerebrovasc Dis
Journal subject:
Vascular Diseases
/
Brain
Year:
2020
Document Type:
Article
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