Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia.

Autor:	Ramos-Pachón A; Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain, aramos@igtp.cat., García-Tornel Á; Stroke Unit, Hospital Universitari Vall D'Hebron-VHIR, Barcelona, Spain., Millán M; Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain., Ribó M; Hospital Universitari Vall D'Hebron-VHIR, Barcelona, Spain., Amaro S; Stroke Unit, Hospital Clínic, Barcelona, Spain., Cardona P; Stroke Unit, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain., Martí-Fàbregas J; Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain., Roquer J; Stroke Unit, Department of Neurology, Mar Hospital, Barcelona, Spain., Silva Y; Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain., Ustrell X; Department of Neurology, Hospital Universitari Joan XXIII, Tarragona, Spain., Purroy F; Department of Neurology, Stroke Unit, Hospital Arnau de Vilanova, Lleida, Spain., Gómez-Choco M; Department of Neurology, Hospital Moisés Broggi, Sant Joan Despí, Spain., Zaragoza-Brunet J; Department of Neurology, Hospital Verge de la Cinta, Tortosa, Spain., Cánovas D; Department of Neurology, Hospital Parc Taulí, Sabadell, Spain., Krupinski J; Department of Neurology, Hospital Mútua Terrassa, Terrassa, Spain., Sala NM; Department of Neurology, Hospital Sant Joan de Déu - Fundació Althaia, Manresa, Spain., Palomeras E; Department of Neurology, Hospital Mataró, Mataró, Spain., Cocho D; Department of Neurology, Hospital General Granollers, Granollers, Spain., Redondo L; Emergency Department, Hospital Universitari Vic, Vic, Spain., Repullo C; Emergency Department, Fundació Hospital Seu Urgell, La Seu d'Urgell, Spain., Sanjurjo E; Emergency Department, Hospital del Pallars, Tremp, Spain., Carrión D; Emergency Department, Hospital Mora Ebre, Mora Ebre, Spain., López M; Emergency Department, Hospital Figueres, Figueres, Spain., Almendros MC; Emergency Department, Hospital Palamós, Palamós, Spain., Barceló M; Emergency Department, Hospital Cerdanya, Puigcerdà, Spain., Monedero J; Medical Director, Hospital Igualada, Igualada, Spain., Catena E; Department of Neurology, Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedés, Spain., Rybyeba M; Emergency Department, Fundació Hospital d'Olot, Olot, Spain., Diaz G; Emergency Department, Hospital Campdevànol, Campdevànol, Spain., Jiménez-Fàbrega X; Sistema d'Emergències Mèdiques, Barcelona, Spain., Solà S; Sistema d'Emergències Mèdiques, Barcelona, Spain., Hidalgo V; Hospital del Mar, Barcelona, Spain., Pueyo MJ; Departament de Salut de Catalunya, Catsalut, Barcelona, Spain., Pérez de la Ossa N; Catalan Stroke Program, Hospital Universitari Germans Trias i Pujol, Badalona, Spain., Urra X; Stroke Unit, Hospital Clínic, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	Cerebrovascular diseases (Basel, Switzerland) [Cerebrovasc Dis] 2021; Vol. 50 (5), pp. 551-559. Date of Electronic Publication: 2021 May 21.
DOI:	10.1159/000516309
Abstrakt:	Introduction: The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system's bottlenecks from a territorial point of view. Methods: Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15-May 2, 2020) and an immediate prepandemic period (January 26-March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. Results: Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = -0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05-2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4-0.9], p 0.015) during the pandemic period. Conclusion: During the COVID-19 pandemic, Catalonia's stroke system's weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system's analysis is crucial to allocate resources appropriately. (© 2021 S. Karger AG, Basel.)
Databáze:	MEDLINE
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