Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia
Por:
Ramos-Pachon, A, Garcia-Tornel, A, Millan, M, Ribo, M, Amaro, S, Cardona, P, Marti-Fabregas, J, Roquer, J, Silva, Y, Ustrell, X, Purroy, F, Gomez-Choco, M, Zaragoza-Brunet, J, Canovas, D, Krupinski, J, Sala, NM, Palomeras, E, Cocho, D, Redondo, L, Repullo, C, Sanjurjo, E, Carrion, D, Lopez, M, Almendros, MC, Barcelo, M, Monedero, J, Catena, E, Rybyeba, M, Diaz, G, Jimenez-Fabrega, X, Sola, S, Hidalgo, V, Pueyo, MJ, de la Ossa, NP and Urra, X
Publicada:
1 sep 2021
Ahead of Print:
1 may 2021
Resumen:
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.
Filiaciones:
:
Hosp Badalona Germans Trias & Pujol, Stroke Unit, Badalona, Spain
Garcia-Tornel, A:
Hosp Univ Vall Hebron VHIR, Stroke Unit, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Stroke Unit, Badalona, Spain
Ribo, M:
Hosp Univ Vall Hebron VHIR, Barcelona, Spain
Amaro, S:
Hosp Clin Barcelona, Stroke Unit, Barcelona, Spain
Cardona, P:
Hosp Univ Bellvitge, Hosp Llobregat, Stroke Unit, Barcelona, Spain
Marti-Fabregas, J:
Santa Creu & St Pau Hosp, Stroke Unit, Dept Neurol, Barcelona, Spain
Roquer, J:
Mar Hosp, Dept Neurol, Stroke Unit, Barcelona, Spain
Silva, Y:
Hosp Univ Josep Trueta, Stroke Unit, Girona, Spain
Ustrell, X:
Hosp Univ Joan XXIII, Dept Neurol, Tarragona, Spain
Purroy, F:
Hosp Arnau Vilanova, Dept Neurol, Stroke Unit, Lleida, Spain
Gomez-Choco, M:
Hosp Moises Broggi, Dept Neurol, St Joan Despi, Spain
Zaragoza-Brunet, J:
Hosp Verge Cinta, Dept Neurol, Tortosa, Spain
Canovas, D:
Hosp Parc Tauli, Dept Neurol, Sabadell, Spain
Krupinski, J:
Hosp Mutua Terrassa, Dept Neurol, Terrassa, Spain
Sala, NM:
Hosp St Joan Deu, Dept Neurol, Fundacio Althaia, Manresa, Spain
Palomeras, E:
Hosp Mataro, Dept Neurol, Mataro, Spain
Cocho, D:
Hosp Gen Granollers, Dept Neurol, Granollers, Spain
Redondo, L:
Hosp Univ Vic, Emergency Dept, Vic, Spain
Repullo, C:
Fundacio Hosp Seu Urgell, Emergency Dept, La Seu Durgell, Spain
Sanjurjo, E:
Hosp Pallars, Emergency Dept, Tremp, Spain
Carrion, D:
Hosp Mora Ebre, Emergency Dept, Mora Ebre, Spain
Lopez, M:
Hosp Figueres, Emergency Dept, Figueres, Spain
Almendros, MC:
Hosp Palamos, Emergency Dept, Palamos, Spain
Barcelo, M:
Hosp Cerdanya, Emergency Dept, Puigcerda, Spain
Monedero, J:
Hosp Igualada, Igualada, Spain
Catena, E:
Consorci Sanitari Alt Penedes Garraf, Dept Neurol, Vilafranca Del Penedes, Spain
Rybyeba, M:
Fundacio Hosp Olot, Emergency Dept, Olot, Spain
Diaz, G:
Hosp Campdevanol, Emergency Dept, Campdevanol, Spain
Jimenez-Fabrega, X:
Sistema Emergencies Med, Barcelona, Spain
Sola, S:
Sistema Emergencies Med, Barcelona, Spain
Hidalgo, V:
Hosp Mar, Barcelona, Spain
Pueyo, MJ:
Catsalut, Dept Salut Catalunya, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Catalan Stroke Program, Badalona, Spain
Urra, X:
Hosp Clin Barcelona, Stroke Unit, Barcelona, Spain
Green Published, Bronze
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