Effects of the COVID-19 Pandemic on Stroke Patients.

Autor:	Ghanchi H; Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA., Takayanagi A; Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA., Savla P; Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA., Hariri OR; Neurosurgery, Kaiser Permanente-Orange County, Anaheim, USA., Tayag EC; Neurology and Neurosurgery, Desert Regional Medical Center, Palm Springs, USA., Schiraldi M; Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.; Neurosurgery, Redlands Community Hospital, Redlands, USA., Jorgensen L; Stroke Program Coordinator, Arrowhead Regional Medical Center, Colton, USA., Miulli DE; Neurosurgery, Arrowhead Regional Medical Center, Colton, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2020 Aug 24; Vol. 12 (8), pp. e9995. Date of Electronic Publication: 2020 Aug 24.
DOI:	10.7759/cureus.9995
Abstrakt:	Introduction The severe acute respiratory syndrome coronavirus 2 (SARS2-CoV-2) induced pandemic (COVID-19 pandemic) has affected healthcare in all aspects, including stroke care. We sought to investigate this effect with analysis of our hospital's stroke treatment protocols as well as stroke volume on state, regional, and national levels. Methods This was a retrospective review of prospectively collected data from our stroke registry to assess the impact of the SARS2-CoV-2 induced pandemic on the volume of stroke patients presenting to our facility. Demographics collected included age, sex, race, National Institute of Health Stroke Scale (NIHSS) on admission, discharge modified Rankin Score (mRS), type of stroke (ischemic, hemorrhagic, or transient ischemic attack), time of symptom onset, and time to initial imaging. Data were also stratified by date and comparison was made between the intra-COVID-period (March and April 2020), pre-COVID period (March and April 2019), and peri-COVID period (January and February 2020). To determine stroke trends on a national level, we utilized the Get with the Guidelines (GWTG) stroke database to compare stroke volumes in the pre-COVID, peri-COVID, and intra-COVID periods between our hospital, all California hospitals, and the West and Pacific regions. Results There was a significant increase in last known well time (LKWT) to arrival to the emergency department (ED) (LKWT to door) as well as time from arrival to the ED to obtaining a computed tomography (CT) of the head (door to CT) in March 2020 compared to 2019 (p=0.0220 and p=0.0475, respectively). There were significantly fewer transient ischemic attacks (TIAs) in California hospitals as well as in March and April 2020 in comparison to January and February 2020 (p=0.0417). Similarly, there were significantly fewer TIAs in March and April 2019 compared to March and April 2020 (p=0.0360). The decrease in TIAs was also seen at our hospital in both time frame comparisons as well as in West Regional Hospitals in March and April 2020 compared to March and April 2019 (p=0.0111, p=0.0215, and p=0.0414, respectively). Conclusion Stroke care has been disrupted by the COVID-19 pandemic worldwide. We identified a delay in LKWT to door as well as time from door to CT in March 2020 compared to March 2019 at our institution. There was a statistically significant decrease in final diagnosis of TIA at our hospital, all California hospitals, and all West Regional hospitals during the March-April 2020 window, suggesting that some patients with minor stroke symptoms may not be presenting to the hospital in the midst of the pandemic. Strategies to minimize delays in care and maximize functional recovery must continue to evolve as new challenges are met during the COVID-19 pandemic. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2020, Ghanchi et al.)
Databáze:	MEDLINE
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