Stroke Acute Management and Outcomes During the COVID-19 Outbreak: A Cohort Study From the Madrid Stroke Network.
Blanca Fuentes, María Alonso de Leciñana, Sebastián García‐Madrona, Fernando Díaz‐Otero, Clara Aguirre, Patricia Calleja, J. Egido, Joaquín Carneado Ruiz, Gerardo Ruiz‐Ares, Jorge Rodríguez‐Pardo, Ángela Rodríguez‐López, Álvaro Ximénez‐Carrillo, Alicia de Felipe, Fernando Ostos, Guillermo González‐Ortega, Patricia Simal, Carlos I. Gómez Escalonilla, Pablo Gómez‐Porro, Zayrho Desanvicente, Gemma Reig, Antonio Gil-Núñez, Jaime Masjuán, Exuperio Díez‐Tejedor
Abstract
BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: =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). CONCLUSIONS: 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.