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

J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105068. doi: 10.1016/j.jstrokecerebrovasdis.2020.105068. Epub 2020 Jun 20.

Abstract

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.

Keywords: COVID-19; Comprehensive stroke center; Quality research; Stroke.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Betacoronavirus / pathogenicity*
  • Comprehensive Health Care / organization & administration*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / therapy*
  • Coronavirus Infections / virology
  • Critical Pathways / organization & administration
  • Delivery of Health Care, Integrated / organization & administration*
  • Female
  • Humans
  • Male
  • Middle Aged
  • New York City / epidemiology
  • Pandemics
  • Patient Care Team / organization & administration
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / therapy*
  • Pneumonia, Viral / virology
  • Quality Improvement / organization & administration*
  • Quality Indicators, Health Care / organization & administration*
  • Registries
  • Retrospective Studies
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / therapy*
  • Thrombectomy*
  • Thrombolytic Therapy*
  • Time Factors
  • Time-to-Treatment / organization & administration
  • Treatment Outcome
  • Workflow

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2