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Observational Study
. 2021 Apr;42(4):1237-1245.
doi: 10.1007/s10072-021-05045-0. Epub 2021 Jan 15.

Effect of the COVID-19 pandemic and the lockdown measures on the local stroke network

Valerio Brunetti  1 , Aldobrando Broccolini  1   2 , Pietro Caliandro  1 , Riccardo Di Iorio  1 , Mauro Monforte  1 , Roberta Morosetti  1 , Carla Piano  1 , Fabio Pilato  1 , Simone Bellavia  2 , Jessica Marotta  2 , Irene Scala  2 , Alessandro Pedicelli  2   3 , Mariano Alberto Pennisi  2   4 , Anselmo Caricato  2   4 , Cinzia Roberti  5 , Maria Concetta Altavista  5 , Alessandro Valenza  6 , Marisa Distefano  6 , Emanuela Cecconi  6 , Martina Fanella  7 , Sabina Roncacci  7 , Miriam Tasillo  7 , Paolo Calabresi  1   2 , Giovanni Frisullo  8   9   10 , Giacomo Della Marca  1   2
Affiliations
Observational Study

Effect of the COVID-19 pandemic and the lockdown measures on the local stroke network

Valerio Brunetti et al. Neurol Sci. 2021 Apr.

Abstract

Introduction: The COVID-19 outbreak highly impacted the acute ischemic stroke care management. The primary end point of the study was to evaluate the impact of the COVID-19 outbreak and the following lockdown measures on our hub-and-spoke network; the secondary end point was to evaluate if the impact of the COVID-19 outbreak was different in hub-and-spoke centers.

Methods: This was a retrospective multicenter observational study conducted at the Stroke Units of Policlinico Gemelli, Ospedale San Filippo Neri, Ospedale di Belcolle, and Ospedale San Camillo de Lellis. We collected clinical reports of all consecutive patients admitted with diagnosis of acute ischemic stroke or transient ischemic attack (TIA) during the phase 1 of the lockdown period (11 March 2020-4 May 2020). As controls, we used all consecutive patients admitted for acute ischemic stroke or TIA in the same period of the previous year.

Results: A total of 156 and 142 clinical reports were collected in 2019 and 2020, respectively. During the COVID-19 outbreak, we observed a reduction of number of thrombolysis, a reduction of the length of hospitalization, and an increase of pneumonia. Regarding performance indicators, we observed an increase in onset-to-door time and in door-to-groin time. We did not observe any statistically significant interaction between year (2019 vs 2020) and facility of admission (hub vs spoke) on all variables analyzed.

Discussion: Our observational study, involving hub-and-spoke stroke network of a wide regional area, indicates that the COVID-19 outbreak impacted on the acute stroke management. This impact was equally observed in hub as well as in spoke centers.

Keywords: COVID-19; Cerebrovascular disease; Hub; Spoke; Stroke.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Total number of patients admitted, thrombolysis, and thrombectomy: 2019 vs 2020. A significant reduction of total number of thrombolysis was observed in 2020 (19) compared to 2019 (37)
Fig. 2
Fig. 2
Performance indicators of stroke network: 2019 vs 2020. Onset-to-door time and door-to-groin time were significantly longer in 2020. Length of stay in emergency room (ER) was significantly shorter in 2020. No significant modification of door-to-needle time was observed in 2020 compared to 2019
Fig. 3
Fig. 3
Forest plot showing results of multivariate analysis: 2019 vs 2020. Pneumonia and prolonged onset-to-door occurred in year 2020, while prolonged length of stay in ER and of hospitalization occurred in 2019
Fig. 4
Fig. 4
Results of the interaction between time of observation (2019 vs 2020) and site of observation (hub vs spoke). No significant differences were observed for the variables analyzed
See this image and copyright information in PMC

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