Abstract
IntroductionWe investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times.MethodsWe included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017.ResultsA decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status.ConclusionsDuring the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.
Highlights
We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers
During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in door-to-groin time (DGT) was seen, which indicates a target for attention
Health care workers had to follow strict protection measures, which may have affected acute stroke workflows in hospitals [5, 6], especially in COVID-19-positive acute ischemic stroke (AIS)-patients. It remains unclear whether the reported delays and decline in stroke admissions have led to nationwide declines in the number of AIS-patients treated with reperfusion therapy, either intravenous thrombolytics (IVT) and/or endovascular treatment (EVT), in the Netherlands, and if previous door-to-treatment times could be maintained for COVID-19-positive patients
Summary
We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. On March 15th, 2020, the Dutch government implemented a nationwide lockdown in which people were advised to stay home and keep social distance [2] These rules were maintained for nearly two months until May 11th, when several restrictions were abated. Health care workers had to follow strict protection measures, which may have affected acute stroke workflows in hospitals [5, 6], especially in COVID-19-positive (or suspected) acute ischemic stroke (AIS)-patients It remains unclear whether the reported delays and decline in stroke admissions have led to nationwide declines in the number of AIS-patients treated with reperfusion therapy, either intravenous thrombolytics (IVT) and/or endovascular treatment (EVT), in the Netherlands, and if previous door-to-treatment times could be maintained for COVID-19-positive (or suspected) patients
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