Acute Stroke Care Is at Risk in the Era of COVID-19: Experience at a Comprehensive Stroke Center in Barcelona
The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center. On February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision...
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| Veröffentlicht in: | Stroke (1970) Jg. 51; H. 7; S. 1991 |
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| Hauptverfasser: | , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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United States
01.07.2020
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| ISSN: | 1524-4628, 1524-4628 |
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| Abstract | The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center.
On February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision to refrain from reallocating the Stroke Team and Stroke Unit to the care of patients with COVID-19. From March 1 to March 31, 2020, we measured the number of emergency calls to the Emergency Medical System in Catalonia (7.5 million inhabitants), and the Stroke Codes dispatched to Hospital Clinic of Barcelona. We recorded all stroke admissions, and the adequacy of acute care measures, including the number of thrombectomies, workflow metrics, angiographic results, and clinical outcomes. Data were compared with March 2019 using parametric or nonparametric methods as appropriate.
At Hospital Clinic of Barcelona, 1232 patients with COVID-19 were admitted in March 2020, demanding 60% of the hospital bed capacity. Relative to March 2019, the Emergency Medical System had a 330% mean increment in the number of calls (158 005 versus 679 569), but fewer Stroke Code activations (517 versus 426). Stroke admissions (108 versus 83) and the number of thrombectomies (21 versus 16) declined at Hospital Clinic of Barcelona, particularly after lockdown of the population. Younger age was found in stroke admissions during the pandemic (median [interquartile range] 69 [64-73] versus 75 [73-80] years,
=0.009). In-hospital, there were no differences in workflow metrics, angiographic results, complications, or outcomes at discharge.
The COVID-19 pandemic reduced by a quarter the stroke admissions and thrombectomies performed at a Comprehensive Stroke Center but did not affect the quality of care metrics. During the lockdown, there was an overload of emergency calls but fewer Stroke Code activations, particularly in elderly patients. Hospital contingency plans, patient transport systems, and population-targeted alerts must act concertedly to better protect the chain of stroke care in times of pandemic. |
|---|---|
| AbstractList | The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center.
On February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision to refrain from reallocating the Stroke Team and Stroke Unit to the care of patients with COVID-19. From March 1 to March 31, 2020, we measured the number of emergency calls to the Emergency Medical System in Catalonia (7.5 million inhabitants), and the Stroke Codes dispatched to Hospital Clinic of Barcelona. We recorded all stroke admissions, and the adequacy of acute care measures, including the number of thrombectomies, workflow metrics, angiographic results, and clinical outcomes. Data were compared with March 2019 using parametric or nonparametric methods as appropriate.
At Hospital Clinic of Barcelona, 1232 patients with COVID-19 were admitted in March 2020, demanding 60% of the hospital bed capacity. Relative to March 2019, the Emergency Medical System had a 330% mean increment in the number of calls (158 005 versus 679 569), but fewer Stroke Code activations (517 versus 426). Stroke admissions (108 versus 83) and the number of thrombectomies (21 versus 16) declined at Hospital Clinic of Barcelona, particularly after lockdown of the population. Younger age was found in stroke admissions during the pandemic (median [interquartile range] 69 [64-73] versus 75 [73-80] years,
=0.009). In-hospital, there were no differences in workflow metrics, angiographic results, complications, or outcomes at discharge.
The COVID-19 pandemic reduced by a quarter the stroke admissions and thrombectomies performed at a Comprehensive Stroke Center but did not affect the quality of care metrics. During the lockdown, there was an overload of emergency calls but fewer Stroke Code activations, particularly in elderly patients. Hospital contingency plans, patient transport systems, and population-targeted alerts must act concertedly to better protect the chain of stroke care in times of pandemic. The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center.BACKGROUND AND PURPOSEThe purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center.On February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision to refrain from reallocating the Stroke Team and Stroke Unit to the care of patients with COVID-19. From March 1 to March 31, 2020, we measured the number of emergency calls to the Emergency Medical System in Catalonia (7.5 million inhabitants), and the Stroke Codes dispatched to Hospital Clinic of Barcelona. We recorded all stroke admissions, and the adequacy of acute care measures, including the number of thrombectomies, workflow metrics, angiographic results, and clinical outcomes. Data were compared with March 2019 using parametric or nonparametric methods as appropriate.METHODSOn February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision to refrain from reallocating the Stroke Team and Stroke Unit to the care of patients with COVID-19. From March 1 to March 31, 2020, we measured the number of emergency calls to the Emergency Medical System in Catalonia (7.5 million inhabitants), and the Stroke Codes dispatched to Hospital Clinic of Barcelona. We recorded all stroke admissions, and the adequacy of acute care measures, including the number of thrombectomies, workflow metrics, angiographic results, and clinical outcomes. Data were compared with March 2019 using parametric or nonparametric methods as appropriate.At Hospital Clinic of Barcelona, 1232 patients with COVID-19 were admitted in March 2020, demanding 60% of the hospital bed capacity. Relative to March 2019, the Emergency Medical System had a 330% mean increment in the number of calls (158 005 versus 679 569), but fewer Stroke Code activations (517 versus 426). Stroke admissions (108 versus 83) and the number of thrombectomies (21 versus 16) declined at Hospital Clinic of Barcelona, particularly after lockdown of the population. Younger age was found in stroke admissions during the pandemic (median [interquartile range] 69 [64-73] versus 75 [73-80] years, P=0.009). In-hospital, there were no differences in workflow metrics, angiographic results, complications, or outcomes at discharge.RESULTSAt Hospital Clinic of Barcelona, 1232 patients with COVID-19 were admitted in March 2020, demanding 60% of the hospital bed capacity. Relative to March 2019, the Emergency Medical System had a 330% mean increment in the number of calls (158 005 versus 679 569), but fewer Stroke Code activations (517 versus 426). Stroke admissions (108 versus 83) and the number of thrombectomies (21 versus 16) declined at Hospital Clinic of Barcelona, particularly after lockdown of the population. Younger age was found in stroke admissions during the pandemic (median [interquartile range] 69 [64-73] versus 75 [73-80] years, P=0.009). In-hospital, there were no differences in workflow metrics, angiographic results, complications, or outcomes at discharge.The COVID-19 pandemic reduced by a quarter the stroke admissions and thrombectomies performed at a Comprehensive Stroke Center but did not affect the quality of care metrics. During the lockdown, there was an overload of emergency calls but fewer Stroke Code activations, particularly in elderly patients. Hospital contingency plans, patient transport systems, and population-targeted alerts must act concertedly to better protect the chain of stroke care in times of pandemic.CONCLUSIONSThe COVID-19 pandemic reduced by a quarter the stroke admissions and thrombectomies performed at a Comprehensive Stroke Center but did not affect the quality of care metrics. During the lockdown, there was an overload of emergency calls but fewer Stroke Code activations, particularly in elderly patients. Hospital contingency plans, patient transport systems, and population-targeted alerts must act concertedly to better protect the chain of stroke care in times of pandemic. |
| Author | Vargas, Martha Obach, Víctor Amaro, Sergio Renú, Arturo Chamorro, Ángel Jiménez-Fàbrega, Francesc Xavier Llull, Laura Rudilosso, Salvatore Laredo, Carlos Torres, Ferrán Vera, Víctor Urra, Xabier |
| Author_xml | – sequence: 1 givenname: Salvatore surname: Rudilosso fullname: Rudilosso, Salvatore organization: Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.) – sequence: 2 givenname: Carlos surname: Laredo fullname: Laredo, Carlos organization: Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.) – sequence: 3 givenname: Víctor surname: Vera fullname: Vera, Víctor organization: Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.) – sequence: 4 givenname: Martha surname: Vargas fullname: Vargas, Martha organization: Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.) – sequence: 5 givenname: Arturo surname: Renú fullname: Renú, Arturo organization: Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.) – sequence: 6 givenname: Laura surname: Llull fullname: Llull, Laura organization: Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.) – sequence: 7 givenname: Víctor surname: Obach fullname: Obach, Víctor organization: Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.) – sequence: 8 givenname: Sergio surname: Amaro fullname: Amaro, Sergio organization: Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.) – sequence: 9 givenname: Xabier surname: Urra fullname: Urra, Xabier organization: Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.) – sequence: 10 givenname: Ferrán surname: Torres fullname: Torres, Ferrán organization: Biostatistics Unit, Autonomous University of Barcelona, Spain (F.T.) – sequence: 11 givenname: Francesc Xavier surname: Jiménez-Fàbrega fullname: Jiménez-Fàbrega, Francesc Xavier organization: Sistema d'Emergències Mèdiques, Barcelona, Spain (F.X.J.-F.) – sequence: 12 givenname: Ángel surname: Chamorro fullname: Chamorro, Ángel organization: Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.) |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32438895$$D View this record in MEDLINE/PubMed |
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| PublicationDate | 2020-July |
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| PublicationPlace | United States |
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| PublicationTitle | Stroke (1970) |
| PublicationTitleAlternate | Stroke |
| PublicationYear | 2020 |
| References | 32466737 - Stroke. 2020 Jul;51(7):1921-1923 33104482 - Stroke. 2020 Nov;51(11):e322-e323 |
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| Snippet | The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center.
On... The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke... |
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| SubjectTerms | Acute Disease Age Distribution Betacoronavirus Coronavirus Infections - epidemiology COVID-19 Emergency Medical Services - statistics & numerical data Emergency Service, Hospital Hospital Bed Capacity - statistics & numerical data Hospitals, Special - organization & administration Hospitals, Special - statistics & numerical data Hospitals, Urban - organization & administration Hospitals, Urban - standards Humans Intensive Care Units - statistics & numerical data Neuroimaging - statistics & numerical data Pandemics Patient Acceptance of Health Care Patient Admission - statistics & numerical data Pneumonia, Viral - epidemiology Procedures and Techniques Utilization - statistics & numerical data Resource Allocation SARS-CoV-2 Spain - epidemiology Stroke - epidemiology Stroke - surgery Stroke - therapy Thrombectomy - statistics & numerical data Treatment Outcome |
| Title | Acute Stroke Care Is at Risk in the Era of COVID-19: Experience at a Comprehensive Stroke Center in Barcelona |
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