Care For Acute Stroke Patients Research Articles

The Acute Care of Stroke Patients in German Stroke Units-an Analysis of DRG Data From 2021 and 2022.

The Acute Care of Stroke Patients in German Stroke Units-an Analysis of DRG Data From 2021 and 2022.

Abstract WP44: Assessing Timely Care of WI's Critical Access Hospitals Acute Stroke Patients With a Speed and Efficiency Task Force

Introduction: Data indicates that rural residents are at 30% higher risk of stroke. 2 Thirty percent of Wisconsin’s (WI) residents live in a rural area and are more often served by smaller, critical access hospitals (CAH). WI Coverdell Stroke Program (Coverdell) data entry into Get With The Guidelines-Stroke® (GWTG) for 2022 shows 22.3% of stroke patient’s transfer from a spoke, often CAH, to a larger tertiary or hub hospital. To assist Coverdell participating (CAH) in timely care of acute stroke patients, Coverdell, American Heart Association® (AHA), and 32 CAH’s partnered to form a Speed and Efficiency Taskforce (TF). Methods: An agreed upon charter, framework and data goals were established in May 2022. Metrics of EMS pre-notification, arrival to CT, and door to needle (DTN) times were regularly reviewed. Evaluation of patients arriving within 4.5 hours of last known well (LKW), median DTN, and percent DTN < 60 minutes were analyzed in two arrival windows. Hypothesized differences when comparing arrival windows of 0700-1900 and 1901-0659 were that the 1901-0659 window would have extended treatment times due to lack of 24/7 CT coverage and LKW not validated from others. Results: Data analysis for 2022. N=179 • Arrival to CT: 10 minutes faster in 1901-0659 window • Median DTN: 3 minutes faster in 0700-1900 window (71 vs 74 minutes respectively) • % DTN within 60 minutes: 12% higher compliance in 0700-1900 window Conclusions: Coverdell CAH’s are initiating the CT in a timely manner. Times are lower for arrivals between 1901-0659, ruling out delays due to CT tech non-availability. Delays in DTN treatment times within 60 minutes of arrival are more significant in the 1901-0659 arrival timeframe. The potential causes are a delay in telestroke consult with decision to treat, internal hospital delays in mixing and delivering thrombolytics, CT availability, and family/significant others present. Further research regarding arrival time affecting treatment need to be considered.

Abstract WMP57: Systematic Reduction of Neurochecks Overnight Decreases Length of Stay and Post-Stroke Delirium

Introduction: Post-stroke delirium is common and leads to worse short- and long-term outcomes with higher 28-day modified Rankin Score (mRS), longer length of hospitalization, and increased odds of discharge to a nursing home, development of dementia, and death. Circadian rhythm disturbances have been implicated as a core mechanism in the pathogenesis of delirium as well as a common sequela of stroke. Standard of care for acute stroke patients is to receive q1h-q4h neuro checks overnight to ensure stability and these are typically continued throughout hospitalization; however, there is limited evidence to support extended use and frequent checks have been implicated in increased delirium rate. Our pilot study addresses this problem by proactively holding neuro checks overnight on clinically stable patients with the goal of promoting re-institution of circadian rhythm as a delirium prevention measure. Methods: After at least 24 hours of hospitalization, patients who were felt to be clinically stable had neuro checks discontinued overnight between the hours of 8pm and 4am and efforts were made to bundle care around these times. If patients were felt not to be stable enough to reduce neuro checks, neuro checks were continued at the frequency typical of the usual standard of care. Patients were reassessed daily to determine if they were stable for neuro check decrease. The Confusion Assessment Method (CAM) was performed each shift with a positive result indicative of delirium. Results: 290 patients over 12 months were included in the analysis (157 pre-intervention, 133 post-intervention). Demographic data did not differ significantly between groups. After the intervention was initiated, CAM positivity decreased from 34% to 23% (p=0.017). LOS decreased from 6.6 days to 5.1 days (p=0.024). mRS and NIHSS during hospitalization did not significantly change (NIHSS p=0.97, mRS p=0.38). Conclusions: After the introduction of the intervention, delirium rate and length of stay decreased significantly. In conclusion, holding neuro checks overnight for clinically stable patients may decrease delirium rate and length of stay, but require more systematic study.

Abstract WMP41: Neighborhood Social Vulnerability is Associated With Lower Frequency of Stroke Scale Assessment Among Patients With Suspected Stroke

Introduction: High-quality prehospital care during initial assessment by EMS providers can affect downstream care for acute stroke patients. Prehospital guidelines strongly recommend assessing suspected stroke patients with a validated stroke scale and obtaining a blood glucose level, but EMS adherence varies widely. Neighborhood socioeconomic characteristics are associated with stroke incidence and outcomes, but there is little research evaluating their relationship to quality metrics in prehospital stroke care. Hypothesis: Greater neighborhood-level social vulnerability is associated with lower frequency of stroke scale assessment and blood glucose check by EMS for patients with suspected stroke. Methods: We conducted a cross-sectional evaluation of EMS activations for suspected stroke patients in the 2019 ESO Data Collaborative. We included 911 responses where EMS documented a field impression of stroke and excluded activations from an acute health care facility. Neighborhood-level social vulnerability, using CDC’s Social Vulnerability Index (SVI), was assigned to each encounter based on pick-up location. Descriptive statistics were calculated, and mixed effects logistic regression models were fit to assess any relationship between SVI and documentation of stroke scale and blood glucose assessments, controlling for patient and event characteristics and clustering by EMS agency. Results: Among 84,411 patients with suspected stroke, 46% were male, with an average age of 71 years. Stroke scale assessment was documented in 78% of cases, and blood glucose in 88%. Compared to patients in the least vulnerable SVI quartile, those in the most vulnerable SVI quartile had lower odds of documented stroke scale assessment (OR 0.91, 95% CI 0.82, 1.00, p=0.04), but similar odds of documented blood glucose (OR 0.97, 95% CI 0.89, 1.06, p=0.48). High agency-level variation was present for stroke scale (ICC 70%, 95% CI 69, 73). Conclusions: Higher social vulnerability areas may be associated with less frequent stroke scale assessment; however, high agency-level variation indicates that the best targets to improve EMS systems’ compliance with evidence-based guidelines for acute stroke care may be low-performing agencies, regardless of setting.

Risk of stroke in patients with prior VKA or DOAC: A population-based real-world registry analysis.

To date, risk assessment of suffering ischemic and hemorrhagic stroke in individuals under oral anticoagulation (OAC) is limited to hospital-based cohorts and patients with atrial fibrillation. Through the combination of three individual datasets, (1) the population-based Tyrolean Stroke Pathway database, prospectively documenting all (unselected) stroke patients in the entire federal state of the Tyrol and (2) nation-wide prescription data, detailing each reimbursed prescription in Austria as well as (3) the Austrian Stroke Unit Registry, a nation-wide registry comprising data on all patients admitted to any of the 38 stroke units in Austria, we assessed risk of stroke in patients with prior oral anticoagulation and compared characteristics of patients taking direct oral anticoagulants and Vitamin-K-Antagonists. In Austria, oral anticoagulant prescription reimbursements increased from 292,475 in 2015 to 389,407 in 2021. In the Tyrol, prior oral anticoagulation treatment was evident in 586 of 3861 (15.2%) patients with ischemic and 131 of 523 (25.0%) with hemorrhagic stroke, with 20% and 35% of those stroke patients respectively having prior oral anticoagulation due to other indications than non-valvular atrial fibrillation. Considering prescription rates, treatment with direct oral anticoagulants was associated with a reduced stroke risk compared to Vitamin-K-Antagonists, especially in ischemic (1.05% vs 0.62%; RR 0.59, p < 0.001) but also in hemorrhagic stroke, even if less pronounced (0.21% vs 0.14%; RR 0.68, p = 0.06). In Austria, prior intake of direct oral anticoagulants was associated with lower risk of suffering acute large vessel occlusion stroke (RR 0.79, p = 0.003). One in seven patients suffering ischemic and one in four suffering hemorrhagic stroke had prior oral anticoagulation treatment. Both ischemic and hemorrhagic strokes are less frequent in those with direct oral anticoagulant intake compared to those taking Vitamin-K-Antagonists. Establishment of clear standard operating procedures on how to best care for acute stroke patients with oral anticoagulation is essential.

The Impact of Standardized Emergency Care on Acute Stroke Treatment and Recovery Time

Objective: To investigate the clinical benefits derived from the implementation of standardized emergency care for patients experiencing acute strokes. Methods: One hundred cases of acute stroke were categorized based on the admission order, with 50 cases per group. The control group received routine emergency care, while the observation group received standardized emergency care. A comparison of the general observation indicators and complication rates of emergency care was conducted. Results: The observation group exhibited shorter pre-examination and assessment time, quicker physician reception time, faster emergency green channel treatment time, and reduced door-to-needle time compared to the control group (P &lt; 0.05). Moreover, the emergency treatment success rate was higher, and the total number of complications was lower in the observation group than in the control group (P &lt; 0.05). Conclusion: The implementation of standardized emergency care proves effective in reducing treatment and recovery times for acute stroke patients. It enhances the success rate of emergency treatment and diminishes the risk of associated complications. These findings underscore the significance of promoting standardized emergency care for acute stroke patients.

Abstract 228: Suboptimal Door‐to‐Puncture Times: Challenges Faced in the Stroke Alert Workflow

Introduction Advances in stroke care have led to more patients eligible for thrombectomy. With these advances, it has become imperative to create a seamless workflow for thrombectomy candidates to ensure rapid door‐to‐puncture times and, ultimately, improve patient outcomes. We sought to determine what barriers are causing delays in patients’ door‐to‐puncture time. Methods A survey was distributed to all members of the Neurology PGY2, PGY3, PGY4 classes and vascular fellows at our single‐center, Comprehensive Stroke Center. The survey allowed participants to freely respond to questions regarding obstacles they encountered that led to delays in door‐to‐puncture times. All survey responses were anonymized. Results The survey was sent to 32 participants, with 26 responses. Of the 26 responses, 11 respondents (42%) noted that obtaining IV access for CTA/CTP scans was a significant cause of delay. Other responses included lack of availability of family for collateral (23%), CT scanner availability (15%), and length of time to decide if the patient is a thrombectomy candidate (15%). Conclusion The goal of this study was to collect data from the individuals involved in the direct care of acute stroke patients who are thrombectomy candidates. We used their experience to determine which points in the stroke alert workflow led to delays in door‐to‐puncture time. Our survey showed the most consistent delay is obtaining proper IV access for CTA and CTP imaging. This information was valuable and has led to the creation of a coalition between the neurology and emergency medicine departments, nursing, and CT technologists to create a “CODE IV” protocol to be implemented into the stroke alert workflow. We aim to report the change in door‐to‐puncture time after the implementation of this new protocol.

Evaluation of Bian Que Flying Rescue system in rescue and emergency care of acute stroke patients

Evaluation of Bian Que Flying Rescue system in rescue and emergency care of acute stroke patients

Terapia endovascular en el tratamiento del ACV isquémico agudo. Perspectiva en Colombia

La aparición en este año de siete estudios que demuestran la superioridad de la terapia endovascular (TEV) sobre el tratamiento convencional de la trombólisis IV con t-PA en las primeras 4,5 horas posteriores al inicio del ataque cerebrovascular (ACV) isquémico agudo en pacientes con una obstrucción arterial proximal, establece un reto terapéutico para los neurólogos colombianos por el costo social que ocasiona la enfermedad y por las falencias que presenta nuestro sistema de salud para la atención óptima al respecto.&#x0D; Esta revisión crítica de los estudio MR Clean, Escape, Extend IA, Swift Prime, Revascat, Thrace y Therapy, así como de las guías 2015 de la American Heart Association (AHA), analizan la factibilidad e implementación de esta información en Colombia.&#x0D; La administración rápida de la terapia intravenosa con t-PA en estos estudios fortalece su implementación en el país e invita a generar protocolos que incluyan imágenes diagnósticas no invasivas como la angiografía cerebral por escanografía cerebral (CTA) o por resonancia magnética (MRA) que seleccionen a los pacientes con obstrucción proximal para brindarles lo más rápido posible el recurso de una TEV a través de una red hospitalaria del ACV.&#x0D; Los principales retos establecidos son los de allanar las diferencias entre el sector público y privado en la atención de pacientes con ACV isquémico agudo, dotar hospitales públicos con la tecnología y el talento humano que la TEV exige, e integrar una red nacional del ACV.

Stroke thrombolysis given by emergency physicians: The time is here

Emergency Medicine core clinical privileges include administration of thrombolytic therapy for myocardial infarction and stroke. However, emergency medicine providers have created their own paradigm to rely on neurology specialty consultation to treat acute stroke patients. A 2013 study supported by the American Academy of Neurology showed an 11% shortage of neurologists at that time and projected a 19% shortage by 2025. The lack of neurologists is a worldwide problem. To help ease the shortage, teleneurology and telestroke care has been implemented by neurologists, most notably for acute ischemic stroke (AIS) patients. We present a model in which an Emergency Medicine (EM) Stroke Champion (SC); an EM physician within our Neurologic Emergency Department, directs care for acute stroke patients at our comprehensive hub and primary stroke center spoke hospitals. The SCs independently treat patients with fibrinolytic therapy and provide teleneurology to fellow emergency physicians caring for acute stroke patients at spoke hospitals. Over nineteen months the SCs received 457 phone calls for patients meeting stroke alert criteria. Sixteen patients were deemed eligible for IV alteplase with one hemorrhagic conversion (6.25%). Sixty-four patients required transfer, and this was facilitated by the SCs. The concept of emergency physician SCs providing teleneurology consultation to other fellow emergency physicians was found to be feasible and safe. This model has the potential to be generalized not to just stroke champions, but to all emergency physicians to feel both confident and comfortable treating acute stroke patients.

Abstract 48: Outcomes And Risk Of Hemorrhagic Transformation Following Mechanical Thrombectomy In Primary Distal Posterior Cerebral Artery Occlusions-subgroup Analysis From STAR

Background: While mechanical thrombectomy (MT) has become the standard of care for acute stroke patients presenting with large vessel occlusion (LVO) and salvageable brain tissue, limited data is currently available regarding the benefits of MT in patents with medium vessel occlusions (MeVO) especially in the posterior circulation (P2 occlusions). Methods: We used the Stroke Thrombectomy and Aneurysm registry (STAR) which included data from 35 stroke centers in North America, Europe, Asia, and South America. We included patients who presented with MeVO in the M2, M3 or P2 segments and underwent MT. We used a Generalized Linear Model to assess the relationship between location of occlusion and outcomes. Results: 9812 patients were included in STAR at the time of this analysis; 43 underwent MT for P2 occlusion, 130 underwent MT for M3 occlusion; and 1273 underwent MT for M2 occlusion. There was no difference in age, sex, race, rate of IV-tPA and stroke severity between patients in all 3 groups (Table 1). There was a trend toward lower rate of atrial fibrillation in patients with P2 and M3 occlusions. Patients with P2 occlusions were less likely to achieve successful recanalization (modified treatment in cerebral infarction score≥2b); intraarterial thrombolysis was used less in P2 occlusions (4.7% compared to 16.2% in M3 occlusions and 10.1% in M2 occlusions). However, there was no difference in the rate of successful first pass. On multivariable analysis, P2 occlusions were not associated with hemorrhagic transformation (OR 2.0, 95% CI 0.7-5.7, P 0.186), 90-day mortality (OR 0.5, 95% CI 0.2-1.4, P 0.183), or 90-day favorable outcome (OR 2.0, 95% CI 0.9-4.4, P 0.084). Conclusions: In this multicenter study, there was no significant difference in safety and efficacy of MT in patients with MeVOs in posterior circulation (P2 occlusions) compared to M2 and M3 occlusions. Improved techniques for successful recanalization are needed for posterior circulation MeVOs.

Abstract WMP21: Virtual Reality Module For Stroke Education

Introduction: E-learning has been used to evaluate competency in hospital staff for many years, with virtual reality (VR) education becoming more popular over the last fifteen years. In 2020, a rural hospital in Indiana partnered with a local technology vendor to create a VR experience for stroke education. The goal was to train nurse and physician staff on the triage, assessment, and care of acute stroke patients in the emergency room setting, upholding the standards set forth by the accrediting agency. Research began to provide qualitative data regarding this educational platform. Methods: The VR platform included video education, hospital specific resources, and an immersive 360 video assessment of an acute stroke patient videotaped on the hospital’s campus. An introductory video demonstrated how to use the learning platform. The module was competency based, meaning staff could receive a maximum of 58 questions, with the quiz function shutting off after the participant scored an 80%. Thirty-five hospital staff were asked to complete the beta test. Twelve of those staff members completed the module and provided feedback via an anonymous eight question survey embedded in the VR platform. The survey included three open ended questions that provided an opportunity for staff to share feedback. Results: Overall, participants expressed that the educational platform was hospital specific, engaging, and technologically advanced. All participants were able to achieve a passing score on the first attempt. Unfortunately, there was a glitch in the system that made the passing score 68%, which was lower than the desired competency of 80%. Over half of the participants rated the VR module as very good or excellent on a five point scale. Staff feedback revealed multiple technical issues with video lag time and challenges with the automated narration of the quiz questions. Conclusion: In conclusion, the VR educational module was found to be an effective form of stroke education for hospital staff. Following the analysis of the beta test results, the core research team was able to adjust the VR module to decrease lag time, remove the auto narration, increase the passing score to 80%, and improve the navigation features to make the learning environment more learner friendly.

How Can We Help? Using Patient-Reported Outcomes to Improve Post Stroke Care

<h3>Research Objectives</h3> The International Consortium on Health Outcome Measurement (ICHOM) has developed a standardized stroke dataset that includes patient reported outcome measures (PROMs). This study aims to explore staff perspectives on the implementation and clinical utility of PROMs dataset and assess the quality of the data captured within the dataset. <h3>Design</h3> A mixed methods, quantitative-qualitative study design. All interviews were audio-recorded and transcribed. Content analysis was conducted to identify common, overarching themes. <h3>Setting</h3> Two regional centers specializing in acute care of stroke patients. <h3>Participants</h3> Staff employed in stroke clinical neurosciences who were involved in the development, implementation, and/or completion of the PROMs dataset. <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Semi-structured, qualitative interviews were conducted, as well as a data quality evaluation. <h3>Results</h3> A total of six interviews were conducted. While the dataset was acknowledged to be a valuable tool, and thought to be important in the identification and management of patients' needs, staff did not use the data captured in their clinical practice. In terms of data quality, less than a quarter (23.4%) of patients received a follow-up call during the study period; however, of those that did, 95.8% agreed to complete the PROMs. Common barriers to implementation included high staff turnover, lack of time, and/or availability of an appropriately qualified person for data collection. <h3>Conclusions</h3> Staff were supportive of a program which could provide monitoring, oversight, and follow-up of stroke patients after discharge from acute care. However, the utility of the dataset is heavily dependent on having the data collection process being properly resourced. <h3>Author(s) Disclosures</h3> None.

Sensitivity to Change and Responsiveness of The Fugl-Meyer Assessment - Upper Extremity in Individuals With Moderate To Severe Acute Stroke

<h3>Research Objectives</h3> The aims of this study were to determine the responsiveness and sensitivity of the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) in severe post-stroke individuals from the acute to subacute phase after stroke with standard clinical care. <h3>Design</h3> Secondary analysis of data from the Stroke Motor Rehabilitation and Recovery Study (SMaHRT), a natural history longitudinal cohort study (www.clinicaltrials.gov, NCR03485040). Data from the acute hospitalization and 6-week follow-up were included. Sensitivity to change was measured using Cohen's effect size, standardized response means (SRM), standard error of measurement (SEM), and minimal detectable change (MDC). Responsiveness, or minimal clinically important difference (MCID), was estimated using receiver operating characteristic (ROC) curves. <h3>Setting</h3> Inpatient stroke service at Massachusetts General Hospital (MGH) <h3>Participants</h3> Participants were included if they were admitted to the inpatient stroke service and had an FMA-UE score < 47 and complete data at 6-week follow-up (n=52). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> FMA-UE, Global Rating of Change Scale (GROC) - Arm Weakness, GROC - Overall Recovery, Modified Rankin Scale (mRS). <h3>Results</h3> Analysis using Cohen's d and the SRM revealed large effect sizes, indicating high sensitivity to change, d = 0.90, 95%CI [0.58, 1.23], SRM = 1.10. Results for the SEM and MDC were 2.45 and 6.78, respectively. ROC analysis indicated that the change in FMA-UE scores was able to distinguish between participants who experience clinically meaningful change from those who did not based on participant-reported GROC scores and clinician-reported mRS scores. The AUC values were statistically significant at a p<0.05 level for the GROC Arm Weakness, GROC Recovery, and mRS anchors. The MCID estimates for the total sample were 13, 12, and 9 anchored to the GROC Arm Weakness, GROC recovery, and mRS, respectively. <h3>Conclusions</h3> The results of our study indicate that the estimated MCID for the FMA-UE in the acute to subacute phase for individuals with moderate to severe impairment is 13, supported by several anchors. These estimates will guide clinical decision-making in the care for acute stroke patients by helping to identify meaningful change in motor impairment that is both beyond measurement error and clinically meaningful. <h3>Author(s) Disclosures</h3> N/A.

"Too Beautiful" Sylvan Artery

Despite the advent and increasing availability of magnetic resonance imaging, the imaging modality of choice in the acute care of stroke patients in many institutions remains CT. The hyperdense artery sign is the primary marker of acute ischaemic stroke. We report the case of a 70-year-old patient, in whom brain CT without contrast injection performed́ in emergency following a neurological deficit, allowed the objectification of an early ischemic stroke.

Improving the Prehospital Identification and Acute Care of Acute Stroke Patients: A Quality Improvement Project.

Background There are a large number of stroke patients in China, and there is currently a lack of prehospital acute stroke care training programs. Aim To develop a prehospital emergency medical service (PEMS) training program to improve the prehospital identification and acute care of acute stroke. Methods Forty prehospital emergency doctors whose service stations are located within a 10 km radius from Shanghai Pudong New Area Medical Emergency Service Center took this course on November 13, 2014. A questionnaire was designed to evaluate the PEMS personnel's knowledge in stroke and acute stroke care and was conducted before and after training as an assessment of the effectiveness of training. The patient population in this study included a baseline cohort before training and a prospective cohort after training, each composed of patients who were sent to Shanghai East Hospital South Stoke Center within one year. The transit time, final diagnosis, administration of thrombolysis, and door-to-needle time (DNT) were collected and analyzed. Results After the training, 100% of the PEMS personnel were competent to identify stroke cases using the Cincinnati prehospital stroke scale (CPSS). All participants realized that intravenous thrombolysis therapy in a time-sensitive manner is the most effective way to treat acute ischemic stroke. Although there was no difference in first-aid transit time before and after training, the stroke diagnosis rate improved by 6.5% after training (P=0.03). The thrombolysis rate increased to 29.6% from 24.3% but did not reach statistical significance. Compared to 84.0 minutes (standard deviation: 23.1 minutes) before the training, the average DNT after training was 53 minutes (standard deviation: 15.0 minutes), demonstrating a remarkable reduction (P < 0.01). Conclusion The training program effectively improved the PEMS personnel's knowledge in stroke and stroke acute care.

Abstract WP30: Zoom Or In The Room, Meeting The Stroke Education Standard

Background: Comprehensive Stroke Center nurses are required to receive 8 hours of stroke education annually; meeting this objective has been a challenge for administrators due to staffing shortages as well as the need to social distance during the COVID pandemic prompting virtual learning as a method to meet these standards. Web based courses often lack the multiplicity of diverse learning modalities needed for success. Purpose: Our objective was to provide a meaningful way to provide stroke education using the six perceptual modalities needed for adult learning which included visual, aural, printed, tactile, interactive, and kinesthetic learning. Methods: The stroke administrative team conducted a needs analysis based on nursing requests, outcome metrics, and requirements of the Joint Commission. A hybrid approach was delivered to the staff using four hours of classroom didactics, three hours of online classes, and one hour of education at hospital skills fairs, and unit meetings. Classrooms utilized social distancing, requiring multiple classes to be offered. Results: Nurses were surveyed with a 12 question Likert scale about how well they were prepared to integrate learned material into clinical practice comparing both virtual and live modalities. They were also asked about individual learning modalities. Twenty-five people responded to the survey. Only 12% of virtual learner respondents felt strongly prepared to care for stroke patients compared to 76% of classroom learners. Seventy-nine percent preferred classroom learning compared to 17% virtual, with a 4% hybrid preference. Learning preferences were multifactorial for visual, aural, printed, tactile, interactive, and kinesthetic learning being 95%, 48%, 56%, 40%, 11%, and 20% respectively. Conclusions: Virtual learning provides solutions in difficult situations, however classroom education is the preferred method of learning for healthcare professionals delivering evidenced based care for acute stroke patients. Planning committees should at least consider a hybrid approach that offer classroom time to caregivers.

Impact of COVID-19 pandemic on acute stroke care-data analysis from the RES-Q registry 2020 in N. Macedonia

Since 2017, the Department of Urgent Neurology at the University Clinic of Neurology in N. Macedonia has implemented the Angels Initiative and the RES-Q Registry, in order to evaluate and optimize the quality of care of acute stroke patients. The aim was to analyze acute stroke data in 2020 and evaluate the impact of COVID-19 pandemic on acute stroke care.

Stroke and Thromboprophylaxis in the Era of COVID-19

Stroke and Thromboprophylaxis in the Era of COVID-19

Clinician's Perception of Practice Changes for Stroke During the COVID-19 Pandemic

BackgroundApproach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey. MethodsA 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication. ResultsRespondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P = 0.047, 95% CI: 1.004–1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P = 0.052, 95% CI: 0.988–10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P = 0.023, 95% CI: 1.110–4.132). ConclusionOur study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. There is also a reported reduction in stroke volume across hospitals. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients.