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. 2022 Jan 11;22(1):22.
doi: 10.1186/s12883-021-02539-4.

Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands

Faysal Benali #  1 , Lotte J Stolze #  2 , Anouk D Rozeman  3 , Wouter Dinkelaar  3 , Jonathan M Coutinho  2 , Bart J Emmer  2 , Rob A R Gons  4 , Lonneke F S Yo  4 , Julia H van Tuijl  5 , Issam Boukrab  5 , Dianne H K van Dam-Nolen  6 , Ido R van den Wijngaard  7 , Geert J Lycklama À Nijeholt  7 , Karlijn F de Laat  8 , Lukas C van Dijk  8 , Heleen M den Hertog  9 , H Zwenneke Flach  9 , Marieke J H Wermer  10 , Marianne A A van Walderveen  10 , Paul J A M Brouwers  11 , Tomas Bulut  11 , Sarah E Vermeer  12 , Marie Louise E Bernsen  12 , Maarten Uyttenboogaart  13 , Reinoud P H Bokkers  13 , Jeroen D Boogaarts  14 , Frank-Erik de Leeuw  14 , H Bart van der Worp  15 , Irene C van der Schaaf  15 , Wouter J Schonewille  16 , Jan A Vos  16 , Michel J M Remmers  17 , Farshad Imani  17 , Diederik W J Dippel  6 , Wim H van Zwam  18 , Paul J Nederkoorn #  2 , Robert J van Oostenbrugge #  18
Affiliations

Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands

Faysal Benali et al. BMC Neurol. .

Abstract

Introduction: We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times.

Methods: We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017.

Results: A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status.

Conclusions: During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.

Keywords: Acute stroke care; COVID-19; Endovascular thrombectomy; Intravenous thrombolytics; Lockdown; NIHSS.

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Conflict of interest statement

All other authors don’t have any conflicts of interest

Figures

Fig. 1
Fig. 1
Number of EVTs per month of all Dutch comprehensive stroke centers from May 12th, 2017 until May 11th, 2020. The red dots represent the lockdown months. The grey and blue area represent the 95 and 99% confidence interval of the regression line (based on the non-COVID months) respectively. The monthly numbers are based on the period ranging from the 12th of the previous month to the 11th of the mentioned month; i.e. October 2018 includes data from September 12th, 2018 until October 11th, 2018
See this image and copyright information in PMC

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