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Acute stroke care in a New York City comprehensive stroke center during the COVID-19 pandemic

BACKGROUND AND PURPOSE: The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City. We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on t...

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Detalles Bibliográficos
Autores principales: Agarwal, Shashank, Scher, Erica, Rossan-Raghunath, Nirmala, Marolia, Dilshad, Butnar, Mariya, Torres, Jose, Zhang, Cen, Kim, Sun, Sanger, Matthew, Humbert, Kelley, Tanweer, Omar, Shapiro, Maksim, Raz, Eytan, Nossek, Erez, Nelson, Peter K., Riina, Howard A., de Havenon, Adam, Wachs, Michael, Farkas, Jeffrey, Tiwari, Ambooj, Arcot, Karthikeyan, Parella, David Turkel, Liff, Jeremy, Wu, Tina, Wittman, Ian, Caldwell, Reed, Frontera, Jennifer, Lord, Aaron, Ishida, Koto, Yaghi, Shadi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305900/
https://www.ncbi.nlm.nih.gov/pubmed/32807471
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105068
Descripción
Sumario:BACKGROUND AND PURPOSE: The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City. We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on the quality of care for patients presenting with acute ischemic stroke (AIS). METHODS: We retrospectively analyzed data from a quality improvement registry of consecutive AIS patients at New York University Langone Health's CSC between 06/01/2019-05/15/2020. During the early stages of the pandemic, the acute stroke process was modified to incorporate COVID-19 screening, testing, and other precautionary measures. We compared stroke quality metrics including treatment times and discharge outcomes of AIS patients during the pandemic (03/012020-05/152020) compared with a historical pre-pandemic group (6/1/2019-2/29/2020). RESULTS: A total of 754 patients (pandemic-120; pre-pandemic-634) were admitted with a principal diagnosis of AIS; 198 (26.3%) received alteplase and/or mechanical thrombectomy. Despite longer median door to head CT times (16 vs 12 minutes; p = 0.05) and a trend towards longer door to groin puncture times (79.5 vs. 71 min, p = 0.06), the time to alteplase administration (36 vs 35 min; p = 0.83), door to reperfusion times (103 vs 97 min, p = 0.18) and defect-free care (95.2% vs 94.7%; p = 0.84) were similar in the pandemic and pre-pandemic groups. Successful recanalization rates (TICI≥2b) were also similar (82.6% vs. 86.7%, p = 0.48). After adjusting for stroke severity, age and a prior history of transient ischemic attack/stroke, pandemic patients had increased discharge mortality (adjusted OR 2.90 95% CI 1.77 – 7.17, p = 0.021) CONCLUSION: Despite unprecedented demands on emergency healthcare services, early multidisciplinary efforts to adapt the acute stroke treatment process resulted in keeping the stroke quality time metrics close to pre-pandemic levels. Future studies will be needed with a larger cohort comparing discharge and long-term outcomes between pre-pandemic and pandemic AIS patients.