Dados do Trabalho

Título

IMPACT OF COVID-19 ON ACUTE STROKE CARE

Resumo

Introduction: The COVID-19 pandemic had impact on stroke care around the world, but middle and low-income countries may have struggled more to adapt to the rapid changes in workflow because of its more fragile health care systems. At Hospital das Clínicas/University of São Paulo, major changes were made in the stroke workflow after the onset of the pandemic.

Aims: To assess changes in metrics of acute ischemic stroke care at a large-volume hospital, before and after the pandemic.

Methods: In this prospective, observational study we compared key performance measures collected from the University of Sao Paulo Stroke Data Base, one year before and one year after the report of the first cases of COVID-19 in São Paulo.

Results: We analyzed 1.584 stroke admissions: 797 from March 16, 2019 to March 15, 2020 and 787 from March 16, 2020 to March 15, 2021. There were no statistically significant differences between patients admitted during the two periods regarding age, sex or NIH Stroke Scale (NIHSS) scores. Before the pandemic, 132 procedures of intravenous thrombolysis (IVT) and 29 mechanical thrombectomies (MT) were performed and afterwards, 110 IVT and 19 MT. There was no statistically significant difference in the monthly average between the one-year periods for stroke admissions, IVT or MT. After the pandemic, there was an increase in ictus-to-admission and door-to-imaging (DTI) times compared to before, but there were no statistically significant differences regarding door-to-needle time (DTN) or door-to-puncture (DTP) times.

Conclusions: In the largest medical center from Latin America, despite significant increases in delays in the interval from onset of symptoms of stroke to admission, as well as from admission to performance of CT scans, median DTN times did not significantly change and remained below 45 minutes. Median DTP times did not significantly change, possibly due to the limited power, given the relatively low number of thrombectomy procedures performed. Training of the stroke team and maintenance of high volumes of patients may have contributed to the lack of significant difference in key performance metrics.

Palavras Chave

thrombolysis, metrics, thrombectomy, COVID-19, performance indicator