Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands
Benali, Faysal; Stolze, Lotte J; Rozeman, Anouk D; Dinkelaar, Wouter; Coutinho, Jonathan M; Emmer, Bart J; Gons, Rob A R; Yo, Lonneke F S; van Tuijl, Julia H; Boukrab, Issam; van Dam-Nolen, Dianne H K; van den Wijngaard, Ido R; Lycklama À Nijeholt, Geert J; de Laat, Karlijn F; van Dijk, Lukas C; den Hertog, Heleen M; Flach, H Zwenneke; Wermer, Marieke J H; van Walderveen, Marianne A A; Brouwers, Paul J A M; Bulut, Tomas; Vermeer, Sarah E; Bernsen, Marie Louise E; Uyttenboogaart, Maarten; Bokkers, Reinoud P H; Boogaarts, Jeroen D; de Leeuw, Frank-Erik; van der Worp, H Bart; van der Schaaf, Irene C; Schonewille, Wouter J; Vos, Jan A; Remmers, Michel J M; Imani, Farshad; Dippel, Diederik W J; van Zwam, Wim H; Nederkoorn, Paul J; van Oostenbrugge, Robert J
(2022) BMC Neurology, volume 22, issue 1
(Article)
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
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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.
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Keywords: COVID-19, Communicable Disease Control, Endovascular Procedures, Humans, Netherlands/epidemiology, Pandemics, SARS-CoV-2, Stroke/drug therapy, Thrombectomy, Thrombolytic Therapy, Time-to-Treatment, Treatment Outcome, NIHSS, Acute stroke care, Endovascular thrombectomy, Lockdown, Intravenous thrombolytics, Clinical Neurology, Journal Article
ISSN: 1471-2377
Publisher: BioMed Central
Note: Funding Information: Diederik WJ Dippel: Reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. Funding Information: Frank-Erik de Leeuw: supported by a clinical established investigator grant of the Dutch Heart Foundation (grant 2014 T060), and by a VIDI innovational grant from The Netherlands Organization for Health Research and Development, ZonMw (grant 016126351). Furthermore, he is associate editor of the International Journal of Stroke. Publisher Copyright: © 2022, The Author(s).
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