Universal laboratory testing for SARS-CoV-2 in hyperacute stroke during the COVID-19 pandemic

Abstract

Objective: Stroke patients are thought to be at increased risk of Coronavirus Disease 2019 (COVID-19). To evaluate yield of universal laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in acute stroke patients and its impact on hyperacute stroke care.

Methods: Between weeks 14 and 18 in 2020, a protected code stroke protocol including infection control screening and laboratory testing for SARS-CoV-2 was prospectively implemented for all code stroke patients upon arrival to the emergency department. If infection control screen was positive, patients received protective hygienic measures and laboratory test results were available within four hours from testing. In patients with negative screen, laboratory results were available no later than the next working day. Door-to-imaging times of patients treated with thrombolysis or thrombectomy were compared with those of patients treated during the preceding weeks 1 to 13 in 2020.

Results: During the 4-weeks study period, 116 consecutive code stroke patients underwent infection control screen and laboratory testing for SARS-CoV-2. Among 5 (4.3%) patients whose infection control screen was positive, no patient was tested positive for SARS-CoV-2. All patients with negative infection control screens had negative test results. Door-to-imaging times of patients treated with thrombolysis and/or thrombectomy were not different to those treated during the preceding weeks (12 [9-15] min versus 13 [11-17] min, p = 0.24).

Conclusions: Universal laboratory testing for SARS-CoV-2 provided useful information on patients' infection status and its implementation into a protected code stroke protocol did not adversely affect hyperacute stroke care.

Keywords: Acute Stroke; COVID-19; Patient safety; SARS-CoV-2; Stroke protocol.

Fig. 1

Location of study site. Location of study site in Saxony (color-coded map), Germany (grey map) with rates of confirmed infections with SARS CoV-2 based on epidemiological data provided by Robert Koch Institute as of April 30, 2020. (www.rki.de/EN/Home/homepage_node.html).

Fig. 2

Door-to-imaging times plotted against weeks 1-18 in 2020. Coronavirus symbol indicates week 14 when protected code stroke protocol was implemented in hyperacute stroke care.