Duringthe current coronavirus disease (COVID-19) pandemic the primary focus has beenon infected patients and the frontline responders, and this was associated witha reduction of 45% of total admissions to a Stroke Unit in Italy compared tothe same period in 2019, with a higher prevalence of severe stroke atadmission, according to study results published in the Journal of the Neurological Sciences.

Inlight of the changes inflicted by the COVID-19 pandemic, the researchers soughtto explore the effects of the pandemic on stroke management during the firstmonth of Italys lockdown, between March 9 and April 9, 2020.

The retrospective study included all 16 adults (mean age 77 years) hospitalized to the Stroke Unit of the University Medical Hospital of Trieste during the COVID-19 pandemic with symptoms compatible with acute stroke and the researchers compared the clinical features and outcomes of these patients to 29 patients (mean age 78 years) hospitalized to the Stroke Unit in the same period of 2019. All the patients were tested negative to SARS-CoV-2.

Thegroups were similar with regards to demographic characteristics and strokesubtypes. However, the researchers stressed the 45% reduction of totaladmissions, from 29 patients hospitalized in 2019 to 16 patients admittedduring the recent lockdown.

Theprevalence of severe stroke, defined as NIH stroke scale >10 was higher inthe 2020 cohort, compared to those hospitalized in 2019 (50% vs 28%,respectively). In addition, the mean length of hospital stay was shorter in theCOVID-19 era, compared to 2019. The researchers suggest that the more severeclinical presentation and the faster time course to discharge might be thecause for the worse functional outcomes in the recent cohort, despite a similarproportion of treated patient in 2019 and 2020.

Theemergency structured pathway for acute stroke included separated emergencydepartment and Stroke Unit areas, along with extensive and early use of swabs.This approach allowed the medical teams to offer effective and timelyreperfusion treatments to appropriate patients while protect the staff andother inpatients from infection.

Strokeof unknown symptom onset was more common in the 2020 cohort (50% vs 10%) andthe number of patients that were discharged following a complete stroke work-upwas lower, compared to those admitted in 2019 (31% vs 69%, respectively).

Theadopted strategies for stroke management during the COVID-19 emergency havesuggested being effective, while suffering a reduced and delayed reporting ofsymptoms, concluded the researchers.

Reference

Naccarato M, Scali I, Olivo S, et al. Has COVID-19 played an unexpected stroke on the chain of survival? [published online 4 May 2020]. J Neurol Sci. doi: 10.1016/j.jns.2020.116889

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The Effects of COVID-19 on Stroke Management in Italy - Neurology Advisor