scholarly journals Delays in Stroke Onset to Hospital Arrival Time During COVID-19

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2228-2231 ◽  
Author(s):  
Kay-Cheong Teo ◽  
William C.Y. Leung ◽  
Yuen-Kwun Wong ◽  
Roxanna K.C. Liu ◽  
Anna H.Y. Chan ◽  
...  
Keyword(s):  
Hong Kong ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Arrival Time ◽  
Treatment Time ◽  
Stroke Onset ◽  
Stroke Severity ◽  
Health Crisis ◽  
Hospital Arrival ◽  
Ischemic Attack

Background and Purpose: The current coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis, disrupting emergency healthcare services. We determined whether COVID-19 has resulted in delays in stroke presentation and affected the delivery of acute stroke services in a comprehensive stroke center in Hong Kong. Methods: We retrospectively reviewed all patients with transient ischemic attack and stroke admitted via the acute stroke pathway of Queen Mary Hospital, Hong Kong, during the first 60 days since the first diagnosed COVID-19 case in Hong Kong (COVID-19: January 23, 2020–March 24, 2020). We compared the stroke onset to hospital arrival (onset-to-door) time and timings of inpatient stroke pathways with patients admitted during the same period in 2019 (pre–COVID-19: January 23, 2019–March 24, 2019). Results: Seventy-three patients in COVID-19 were compared with 89 patients in pre–COVID-19. There were no significant differences in age, sex, vascular risk factors, nor stroke severity between the 2 groups ( P >0.05). The median stroke onset-to-door time was ≈1-hour longer in COVID-19 compared with pre–COVID-19 (154 versus 95 minutes, P =0.12), and the proportion of individuals with onset-to-door time within 4.5 hours was significantly lower (55% versus 72%, P =0.024). Significantly fewer cases of transient ischemic attack presented to the hospital during COVID-19 (4% versus 16%, P =0.016), despite no increase in referrals to the transient ischemic attack clinic. Inpatient stroke pathways and treatment time metrics nevertheless did not differ between the 2 groups ( P >0.05 for all comparisons). Conclusions: During the early containment phase of COVID-19, we noted a prolongation in stroke onset to hospital arrival time and a significant reduction in individuals arriving at the hospital within 4.5 hours and presenting with transient ischemic attack. Public education about stroke should continue to be reinforced during the COVID-19 pandemic.

Abstract 101: Educational Level, Emergency Medical Services Activation and Hospital Arrival in Acute Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Gisele S Silva ◽  
Georgiana Andrade Viana ◽  
Cícera Borges Machado ◽  
Bento Fortunato Cardoso dos Santos ◽  
Monique Bueno Alves ◽  
...  
Keyword(s):  
Secondary School ◽  
Acute Stroke ◽  
Emergency Medical Services ◽  
Transient Ischemic Attack ◽  
Educational Level ◽  
Hospital Arrival ◽  
Emergency Medical ◽  
Early Arrival ◽  
School Graduation ◽  
Ischemic Attack

Background: Several studies report that certain factors such as socioeconomic status, living alone or being alone at onset of symptoms play a role in late arrival at hospitals thereby decreasing the ultimate success of medical interventions for stroke patients. There is little research about the influence of educational level upon early arrival in patients with acute stroke. We hypothesized that higher educational level is associated with early arrivals in patients with acute stroke. Methods: We conducted a prospective cohort study to evaluate consecutive patients admitted with a new stroke in 19 hospitals in Fortaleza, Brazil, from April 2009 to April 2012. Educational attainment was categorized into 5 levels: no school attendance, less than secondary school graduation, secondary school graduation, bachelor's degree and master's or doctorate degree. Multiple logistic regressions were used to investigate the influence of epidemiologic and clinical data on the frequency of early arrival (defined as hospital arrival within 4.5 hours from symptoms onset). Results: We evaluated 4679 patients (48% males, mean age: 67.67± 14.48). Ischemic stroke was the most frequent subtype (74.9%) followed by intraparenchymal hemorrhage (14.5%), subarachnoid hemorrhage (5.1%), transient ischemic attack (2.8%), and undetermined stroke (2.7%). A total of 1128 (24.1%) patients arrived within 4.5 hours from symptoms onset. Higher educational level was a predictor of early hospital arrival (p= 0.01). Other univariate predictors of early hospital arrival included having a decreased level of consciousness at presentation OR 1.36 [1.17-1.58], p<0.01, having a hemorrhagic stroke OR 1.46 [1.19-1.79] p<0.01, having a transient ischemic attack OR 2.2 [1.50-3.49] and arriving by emergency medical services (EMS) OR 0.37 [0.31-0.44]. In the multivariate logistic regression analysis, educational level just remains as an independent predictor of early hospital arrival if arriving by EMS is not included in the model. Conclusions: Educational level is associated with early hospital arrival in patients with acute stroke. The association between educational level and early hospital arrival seems to be mediated by activation of the EMS.

scholarly journals Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

2018 ◽  
Vol 13 (9) ◽  
pp. 949-984 ◽  
Author(s):  
JM Boulanger ◽  
MP Lindsay ◽  
G Gubitz ◽  
EE Smith ◽  
G Stotts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Best Practice ◽  
Stroke Care ◽  
Stroke Management ◽  
Practice Recommendations ◽  
Prehospital Emergency ◽  
Ischemic Attack

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

scholarly journals Eligibility for intravenous thrombolysis in acute stroke: A multicenter prospective study

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 372-372
Author(s):  
Enrique Mostacero ◽  
Sonia Santos ◽  
Antonio Davalos ◽  
Alberto Gil-Peralta ◽  
Jose Castillo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Acute Stroke ◽  
Life Support ◽  
Advanced Life Support ◽  
Stroke Onset ◽  
Stroke Severity ◽  
Street Hospital ◽  
Modifiable Factors ◽  
Dispatch System

P182 Objective: To elucidate the proportion of patients who would have been eligible for alteplase treatment following the ECASS II criteria in a prospective study conducted in 20 Spanish general or university hospitals. Methods: The first 100 consecutive patients with an acute stroke admitted between 9/98 and 4/99 in each participating hospital were evaluated. Data concerning exclusion criteria for tPA, demographic variables, distance to hospital (<5km,5–20km,>20km), time (0–6am,6–12,12–6pm,6–12pm) and place (home, work/street, hospital) of symptoms onset, subject detecting the event (victim, family member, bystander), dispatch system (own initiative, EMS, primary physician, community hospital), delay and type of transport (own transport, basic, or advanced life support ambulance), cardiovascular risk factors, stroke severity (Canadian scale) and type of stroke were recorded. Results: Out of 1599 screened patients, 166 (10.4%) fulfilled all criteria for tPA treatment. Multiple reasons for exclusion were time from onset >6h in 23%, or unknown in 23%, delay in neurological attention >6h in 39%, TC not available within 6h from onset in 34%, hemorrhage in 14%, early signs of infarction involving >33% MCA in 8%, TIA or rapidly improving symptoms in 24%, coma or hemiplegia plus forced eye deviation in 5%, hypertension >185/110 in 2%, coagulation abnormalities in 1%, and other reasons in 6%. Univariate analyses showed that high eligibility for tPA was associated with type of the first medical intervention (emergency medical system)(p=0.006), type of transport (basic or advanced life support ambulance)(p<0.0001), stroke severity (p<0.001), and type of stroke (cardioembolic) (p=0.0027). Age, distance to hospital, time and place of stroke onset, subject detecting the event, and risk factors were not significantly related to eligibility. Conclusions: Candidates for intravenous tPA treatment within 6 hours from stroke onset are 10% of patients admitted in general hospitals of an EU country. Delay in neurologic attention and CT examination were the main reasons for exclusion. Dispatch system, and type of transport were modifiable factors related to eligibility.

Frequency of Screening and Prevalence of Neurosyphilis in Stroke Population

2020 ◽  
Vol 49 (3) ◽  
pp. 301-306
Author(s):  
Rodrigo Targa Martins ◽  
Raphael Machado Castilhos ◽  
Pablo Silva da Silva ◽  
Leticia Scaranto Costa
Keyword(s):  
Acute Stroke ◽  
Venereal Disease ◽  
International Classification Of Diseases ◽  
Stroke Severity ◽  
Positive Serology ◽  
Csf Analysis ◽  
Stroke Population ◽  
Classification Of Diseases ◽  
Stroke Center ◽  
Ischemic Attack

Background and Aims: Syphilis and stroke are high prevalent diseases in south Brazil and estimates of concomitance and possible role of syphilis in acute stroke are lacking. Our aims are to estimate the prevalence of syphilis and neurosyphilis (NS) in a cohort of tertiary stroke center. Methods: We reviewed all hospital records of stroke/transitory ischemic attack (TIA) using International Classification of Diseases, 10th revision, at discharge, frequency of syphilis screen, serology positivity, cerebrospinal fluid (CSF) analysis, and prevalence of NS in this stroke population applying CDC criteria. Results: Between 2015 and 2016, there were 1,436 discharges for cerebrovascular events and in 78% (1,119) of these cases, some syphilis screening was performed. We have found a frequency of positive serology for syphilis of 13% (143/1,119), and higher stroke severity was the main determinant for non-screening. Applying standard NS criteria, 4.7% (53/1,119) cases with CSF analysis had NS diagnosis: 8 based on CSF-Venereal Disease Research Laboratory (VDRL) positive and 45 based on abnormal CSF white cells or protein, but CSF VDRL negative. NS VDRL positive cases were younger, had higher serum VDRL title, had more frequent HIV infection, and received NS treatment more often. Demographic and clinical characteristics were not different between NS VDRL negative and non-NS cases. Conclusion: Positive syphilis serology is frequent in patients with acute stroke/TIA in our region. Acute post-stroke CSF abnormalities make the diagnosis of NS difficult in the context of CSF VDRL negative.

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