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Observational Study
. 2020 Oct;29(10):105179.
doi: 10.1016/j.jstrokecerebrovasdis.2020.105179. Epub 2020 Jul 22.

Clinician's Perception of Practice Changes for Stroke During the COVID-19 Pandemic

Hera A Kamdar  1 , Blake Senay  1 , Shraddha Mainali  1 , Vivien Lee  1 , Deepak Kumar Gulati  1 , Diana Greene-Chandos  2 , Archana Hinduja  1 , Tamara Strohm  3
Affiliations
Observational Study

Clinician's Perception of Practice Changes for Stroke During the COVID-19 Pandemic

Hera A Kamdar et al. J Stroke Cerebrovasc Dis. 2020 Oct.

Abstract

Background: Approach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey.

Methods: A 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication.

Results: Respondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P = 0.047, 95% CI: 1.004-1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P = 0.052, 95% CI: 0.988-10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P = 0.023, 95% CI: 1.110-4.132).

Conclusion: Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. There is also a reported reduction in stroke volume across hospitals. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients.

Keywords: Acute Ischemic Stroke; COVID-19; Quality and Outcomes; Stroke management.

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