Prehospital Phase of Acute Stroke Care: Guideline and Policy Considerations as Science and Evidence Rapidly Evolve

Introduction: The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. Methods: Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. Results: Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], p 0.015) during the pandemic period. Conclusion: During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

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Acute Stroke Care during the COVID-19 Pandemic: Reduction in the Number of Admissions of Elderly Patients and Increase in Prehospital Delays

Cerebrovascular Diseases ◽

10.1159/000514140 ◽

2021 ◽

pp. 1-7

Author(s):

Gabriel Velilla-Alonso ◽

Andrés García-Pastor ◽

Ángela Rodríguez-López ◽

Ana Gómez-Roldós ◽

Antonio Sánchez-Soblechero ◽

...

Keyword(s):

Elderly Patients ◽

Acute Stroke ◽

Time Course ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Acute Stroke Care ◽

Group Data ◽

Radiological Data ◽

History Of ◽

Prehospital Delays

Introduction: We analyzed whether the coronavirus disease 2019 (COVID-19) crisis affected acute stroke care in our center during the first 2 months of lockdown in Spain. Methods: This is a single-center, retrospective study. We collected demographic, clinical, and radiological data; time course; and treatment of patients meeting the stroke unit admission criteria from March 14 to May 14, 2020 (COVID-19 period group). Data were compared with the same period in 2019 (pre-COVID-19 period group). Results: 195 patients were analyzed; 83 in the COVID-19 period group, resulting in a 26% decline of acute strokes and transient ischemic attacks (TIAs) admitted to our center compared with the previous year (p = 0.038). Ten patients (12%) tested positive for PCR SARS-CoV-2. The proportion of patients aged 65 years and over was lower in the COVID-19 period group (53 vs. 68.8%, p = 0.025). During the pandemic period, analyzed patients were more frequently smokers (27.7 vs. 10.7%, p = 0.002) and had less frequently history of prior stroke (13.3 vs. 25%, p = 0.043) or atrial fibrillation (9.6 vs. 25%, p = 0.006). ASPECTS score was lower (9 [7–10] vs. 10 [8–10], p = 0.032), NIHSS score was slightly higher (5 [2–14] vs. 4 [2–8], p = 0.122), onset-to-door time was higher (304 [93–760] vs. 197 [91.25–645] min, p = 0.104), and a lower proportion arrived within 4.5 h from onset of symptoms (43.4 vs. 58%, p = 0.043) during the COVID-19 period. There were no differences between proportion of patients receiving recanalization treatment (intravenous thrombolysis and/or mechanical thrombectomy) and in-hospital delays. Conclusion: We observed a reduction in the number of acute strokes and TIAs admitted during the COVID-19 period. This drop affected especially elderly patients, and despite a delay in their arrival to the emergency department, the proportion of patients treated with recanalization therapies was preserved.

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Remote Longitudinal Inpatient Acute Stroke Care Via Telestroke

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.105749 ◽

2021 ◽

Vol 30 (6) ◽

pp. 105749

Author(s):

Fatemeh Sobhani ◽

Shashvat Desai ◽

Evan Madill ◽

Matthew Starr ◽

Marcelo Rocha ◽

...

Keyword(s):

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care

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Effect of Acute Stroke Care Regionalization on Intravenous Alteplase Use in Two Urban Counties

Prehospital Emergency Care ◽

10.1080/10903127.2019.1679303 ◽

2019 ◽

Vol 24 (4) ◽

pp. 505-514 ◽

Cited By ~ 1

Author(s):

Prasanthi Govindarajan ◽

Stephen Shiboski ◽

Barbara Grimes ◽

Lawrence J. Cook ◽

David Ghilarducci ◽

...

Keyword(s):

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care ◽

Intravenous Alteplase

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Disabling stroke in persons already with a disability

Neurology ◽

10.1212/wnl.0000000000008964 ◽

2020 ◽

Vol 94 (7) ◽

pp. 306-310 ◽

Cited By ~ 5

Author(s):

Michael J. Young ◽

Robert W. Regenhardt ◽

Thabele M. Leslie-Mazwi ◽

Michael Ashley Stein

Keyword(s):

Clinical Practice ◽

Health Outcomes ◽

Acute Stroke ◽

Care Delivery ◽

Stroke Care ◽

Clinical Practices ◽

Acute Stroke Care ◽

Persons With Disabilities ◽

Stroke Research ◽

Scant Attention

Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability. These trends may exacerbate unequal health outcomes by rendering novel stroke therapies inaccessible to many persons with disabilities. Here, we explore the underpinnings and implications of biases involving persons with disability in stroke research and practice. Recent insights from bioethics, disability rights, and health law are explained and critically evaluated in the context of prevailing research and clinical practices. Allowing disability to drive decisions to withhold acute stroke interventions may perpetuate disparate health outcomes and undermine ethically resilient stroke care. Advocacy for inclusion of persons with disability in future stroke trials can improve equity in stroke care delivery.

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Review of upper limb ability assessments in acute stroke care, from a practice perspective

International Journal of Therapy and Rehabilitation ◽

10.12968/ijtr.2008.15.12.45424 ◽

2008 ◽

Vol 15 (12) ◽

pp. 678-684

Author(s):

Tennille J Rowland ◽

Louise Gustafsson ◽

Robert D Henderson ◽

Merrill Turpin ◽

Stephen J Read

Keyword(s):

Acute Stroke ◽

Upper Limb ◽

Stroke Care ◽

Acute Stroke Care ◽

Practice Perspective

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FP22-TU-01 Quality of acute stroke care in Thailand, a prospective multicenter countrywide study

Journal of the Neurological Sciences ◽

10.1016/s0022-510x(09)70380-6 ◽

2009 ◽

Vol 285 ◽

pp. S91

Author(s):

Y. Nilanont ◽

S. Nidhinandana ◽

N. Suwanwela ◽

N. Poungvarin

Keyword(s):

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care

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