Stroke Acute Management and Outcomes During the COVID-19 Outbreak: A Cohort Study From the Madrid Stroke Network

• Published in: Stroke (1970) Vol. 52; no. 2; pp. 552 - 562
• Main Authors: Fuentes, Blanca, Alonso de Leciñana, María, García-Madrona, Sebastián, Díaz-Otero, Fernando, Aguirre, Clara, Calleja, Patricia, Egido, José A., Carneado-Ruiz, Joaquín, Ruiz-Ares, Gerardo, Rodríguez-Pardo, Jorge, Rodríguez-López, Ángela, Ximénez-Carrillo, Álvaro, de Felipe, Alicia, Ostos, Fernando, González-Ortega, Guillermo, Simal, Patricia, Gómez Escalonilla, Carlos I., Gómez-Porro-Sánchez, Pablo, Desanvicente, Zayrho, Reig, Gemma, Gil-Núñez, Antonio, Masjuán, Jaime, Díez-Tejedor, Exuperio
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01.02.2021
• Subjects: Aged; Aged, 80 and over; COVID-19 - complications; COVID-19 - epidemiology; Disease Outbreaks - prevention & control; Female; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Retrospective Studies; SARS-CoV-2 - pathogenicity; Stroke - epidemiology; Stroke - virology; COVID-19; stroke, ischemic; pandemic; reperfusion; patients; hemorrhage
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.120.031769

The coronavirus disease 2019 (COVID-19) outbreak has added challenges to providing quality acute stroke care due to the reallocation of stroke resources to COVID-19. Case series suggest that patients with COVID-19 have more severe strokes; however, no large series have compared stroke outcomes with contemporary non-COVID-19 patients. Purpose was to analyze the impact of COVID-19 pandemic in stroke care and to evaluate stroke outcomes according to the diagnosis of COVID-19. Retrospective multicenter cohort study including consecutive acute stroke patients admitted to 7 stroke centers from February 25 to April 25, 2020 (first 2 months of the COVID-19 outbreak in Madrid). The quality of stroke care was measured by the number of admissions, recanalization treatments, and time metrics. The primary outcome was death or dependence at discharge. A total of 550 acute stroke patients were admitted. A significant reduction in the number of admissions and secondary interhospital transfers was found. COVID-19 was confirmed in 105 (19.1%) patients, and a further 19 patients were managed as suspected COVID-19 (3.5%). No differences were found in the rates of reperfusion therapies in ischemic strokes (45.5% non-COVID-19, 35.7% confirmed COVID-19, and 40% suspected COVID-19; =0.265). However, the COVID-19 group had longer median door-to-puncture time (110 versus 80 minutes), which was associated with the performance of chest computed tomography. Multivariate analysis confirmed poorer outcomes for confirmed or suspected COVID-19 (adjusted odds ratios, 2.05 [95% CI, 1.12-3.76] and 3.56 [95% CI, 1.15-11.05], respectively). This study confirms that patients with COVID-19 have more severe strokes and poorer outcomes despite similar acute management. A well-established stroke care network helps to diminish the impact of such an outbreak in stroke care, reducing secondary transfers and allowing maintenance of reperfusion therapies, with a minor impact on door-to-puncture times, which were longer in patients who underwent chest computed tomography.