Abstract
Introduction: The pandemic of coronavirus disease 2019 (COVID-19) has had a significant impact on stroke healthcare, including the prehospital care system and in-hospital workflow. Japan experienced the outbreak of COVID-19, and the State of Emergency was declared during April 2020 and May 2020. The aim of the present study was to clarify the effect of the COVID-19 pandemic on a comprehensive stroke center in Japan.Methods: We retrospectively reviewed consecutive patients with acute ischemic stroke admitted in our institute between December 2019 and July 2020. The patients who underwent reperfusion therapy (intravenous thrombolysis and/or mechanical thrombectomy) were divided into the pre-COVID-19 period (December 2019 to March 2020) and the With-COVID-19 period (April 2020 to July 2020). Study outcomes were the number of stroke admissions in our institute, workflow time metrics, the frequency of modified Rankin Scale score 0–2 at discharge, and brain imaging modalities before reperfusion therapy in patients who underwent reperfusion therapy.Results: In our institute, the number of stroke admissions decreased during the State of Emergency and then increased after the lifting of the State of Emergency. Among patients who underwent reperfusion therapy (median age, 77 years; female 27%; median baseline National Institutes of Health Stroke Scale score, 10), times from hospital arrival to imaging [25 (21–33) min vs. 30 (25–38) min, P = 0.03] and to thrombolysis [38 (31–52) min vs. 51 (37–64) min, P = 0.03] were prolonged compared with the pre-COVID-19 period. There was no significant difference in the frequency of modified Rankin Scale score 0–2 at discharge between the two periods (32 vs. 45%, P = 0.21). The proportion of computed tomography vs. magnetic resonance imaging as an emergency brain imaging tool before reperfusion therapy changed, with computed tomography having become predominant in the With-COVID-19 period.Conclusions: In our institute, the number of stroke admissions, workflow time metrics, and imaging modalities for reperfusion therapy were affected by the COVID-19 pandemic.
Highlights
The pandemic of coronavirus disease 2019 (COVID-19) has had a significant impact on stroke healthcare, including the prehospital care system and in-hospital workflow
We retrospectively reviewed consecutive patients with acute ischemic stroke admitted in our institute between December 2019 and July 2020
The proportion of computed tomography vs. magnetic resonance imaging as an emergency brain imaging tool before reperfusion therapy changed, with computed tomography having become predominant in the With-COVID-19 period
Summary
The pandemic of coronavirus disease 2019 (COVID-19) has had a significant impact on stroke healthcare, including the prehospital care system and in-hospital workflow. The emergence of a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in Wuhan in December 2019 evolved into a pandemic that was declared on March 11, 2020 (1). The COVID-19 global pandemic has a great impact on every aspect of emergency stroke healthcare, including the prehospital care system and the inhospital workflow (5–7). Stroke team members are faced with the novel and significant challenge of providing high-quality emergency treatment while continuing their utmost effort to minimize infectious exposure. From the perspective of the prehospital care system, significant delays in stroke onset to hospital arrival time (9) and reduction of stroke admissions have been reported (10, 11)
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