Abstract
We aimed to assess how evidence-based stroke care changed over the two waves of the COVID-19 pandemic. We analyzed acute stroke patients admitted to a tertiary care hospital in Germany during the first (2 March 2020–9 June 2020) and second (23 September 2020–31 December 2020, 100 days each) infection waves. Stroke care performance indicators were compared among waves. A 25.2% decline of acute stroke admissions was noted during the second (n = 249) compared with the first (n = 333) wave of the pandemic. Patients were more frequently tested SARS-CoV-2 positive during the second than the first wave (11 (4.4%) vs. 0; p < 0.001). There were no differences in rates of reperfusion therapies (37% vs. 36.5%; p = 1.0) or treatment process times (p > 0.05). However, stroke unit access was more frequently delayed (17 (6.8%) vs. 5 (1.5%); p = 0.001), and hospitalization until inpatient rehabilitation was longer (20 (1, 27) vs. 12 (8, 17) days; p < 0.0001) during the second compared with the first pandemic wave. Clinical severity, stroke etiology, appropriate secondary prevention medication, and discharge disposition were comparable among both waves. Infection control measures may adversely affect access to stroke unit care and extend hospitalization, while performance indicators of hyperacute stroke care seem to be untainted.
Highlights
While an exceeding number of patients infected with severe acute respiratory syndromeCoronavirus-2 (SARS-CoV-2) led to relocation of in-hospital resources, time-sensitive treatment of acute stroke needs to be ensured [1]
To reflect increasing infection control measures established in the first and intensified during the further course of the pandemic, we aimed to investigate their impact on inhospital evidence-based stroke care by comparing stroke admissions during the two waves of the pandemic in a severely SARS-CoV-2 affected region in Germany
Patients admitted to hospital during the first wave were as severely affected of stroke as patients admitted to hospital during the second wave of the pandemic, reflected by similar baseline National Institutes of Health Stroke Scale (NIHSS) scores (4 (2, 14) vs. 5 (2, 16), p = 0.36) and displayed a comparable patient history for all cardiovascular risk factors and comorbidities investigated (Table 1)
Summary
While an exceeding number of patients infected with severe acute respiratory syndromeCoronavirus-2 (SARS-CoV-2) led to relocation of in-hospital resources, time-sensitive treatment of acute stroke needs to be ensured [1]. Protected code stroke protocols were established globally during the first wave of the pandemic to maintain timely access to hyperacute interventions, such as intravenous thrombolysis (IVT) and endovascular therapy (EVT), ensure safety of patients, as well as healthcare workers, and preserve best possible in-hospital acute care for patients infected with SARS-CoV-2 [2,3]. To reflect increasing infection control measures established in the first and intensified during the further course of the pandemic, we aimed to investigate their impact on inhospital evidence-based stroke care by comparing stroke admissions during the two waves of the pandemic in a severely SARS-CoV-2 affected region in Germany While multiple studies suggest a global decline in stroke admission and acute intervention rates [4,5,6], there is sparse of data on how many patients were eventually deprived of in-hospital evidence-based stroke care due to the pandemic.
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