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Code Stroke Patient Referral by Emergency Medical Services During the Public COVID-19 Pandemic Lockdown.
J Stroke Cerebrovasc Dis. 2020 Nov; 29(11):105175.JS

Abstract

BACKGROUND

The COVID-19 pandemic caused public lockdowns around the world. We analyzed if the public lockdown altered the referral pattern of Code Stroke patients by Emergency Medical Services (EMS) to our Comprehensive Stroke Center.

METHODS

Retrospective single-center study at a Bavarian Comprehensive Stroke Center. Patients who were directly referred to our stroke unit by EMS between the 1[st] of January 2020 and the 19[th] of April 2020 were identified and number of referrals, clinical characteristics and treatment strategies were analyzed during the public lockdown and before. The public lockdown started on 21[st] of March and ended on 19[th] April 2020.

RESULTS

In total 241 patients were referred to our center during the study period, i.e. 171 before and 70 during the lockdown. The absolute daily number of Code Stroke referrals and the portion of patients with stroke mimics remained stable. The portion of female stroke patients decreased (55% to 33%; p = 0.03), and stroke severity as measured by the National Institutes of Health Stroke Scale (median 3 (IQR 0-7) versus 6 (IQR 1-15.5) points; p = 0.04) increased during the lockdown. There was no difference of daily numbers of patients receiving thrombolysis and thrombectomy.

CONCLUSIONS

Referral of Code Stroke patients by EMS could be maintained sufficiently despite the COVID-19 pandemic lockdown. However, patients' health care utilization of the EMS may have changed within the public lockdown. EMS remains a useful tool for Code Stroke patient referral during lockdowns, but public education about stroke is required prior to further lockdowns.

Authors+Show Affiliations

Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany. Electronic address: benno.ikenberg@tum.de.Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.Department of Cardiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.Department of Trauma Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33066900

Citation

Ikenberg, Benno, et al. "Code Stroke Patient Referral By Emergency Medical Services During the Public COVID-19 Pandemic Lockdown." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 29, no. 11, 2020, p. 105175.
Ikenberg B, Hemmer B, Dommasch M, et al. Code Stroke Patient Referral by Emergency Medical Services During the Public COVID-19 Pandemic Lockdown. J Stroke Cerebrovasc Dis. 2020;29(11):105175.
Ikenberg, B., Hemmer, B., Dommasch, M., Kanz, K. G., Wunderlich, S., & Knier, B. (2020). Code Stroke Patient Referral by Emergency Medical Services During the Public COVID-19 Pandemic Lockdown. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 29(11), 105175. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105175
Ikenberg B, et al. Code Stroke Patient Referral By Emergency Medical Services During the Public COVID-19 Pandemic Lockdown. J Stroke Cerebrovasc Dis. 2020;29(11):105175. PubMed PMID: 33066900.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Code Stroke Patient Referral by Emergency Medical Services During the Public COVID-19 Pandemic Lockdown. AU - Ikenberg,Benno, AU - Hemmer,Bernhard, AU - Dommasch,Michael, AU - Kanz,Karl-Georg, AU - Wunderlich,Silke, AU - Knier,Benjamin, Y1 - 2020/07/21/ PY - 2020/06/23/received PY - 2020/07/15/revised PY - 2020/07/16/accepted PY - 2020/10/17/entrez PY - 2020/10/18/pubmed PY - 2020/10/29/medline KW - COVID-19 KW - Hospital referral KW - Lockdown KW - Stroke KW - Stroke mimic SP - 105175 EP - 105175 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 29 IS - 11 N2 - BACKGROUND: The COVID-19 pandemic caused public lockdowns around the world. We analyzed if the public lockdown altered the referral pattern of Code Stroke patients by Emergency Medical Services (EMS) to our Comprehensive Stroke Center. METHODS: Retrospective single-center study at a Bavarian Comprehensive Stroke Center. Patients who were directly referred to our stroke unit by EMS between the 1[st] of January 2020 and the 19[th] of April 2020 were identified and number of referrals, clinical characteristics and treatment strategies were analyzed during the public lockdown and before. The public lockdown started on 21[st] of March and ended on 19[th] April 2020. RESULTS: In total 241 patients were referred to our center during the study period, i.e. 171 before and 70 during the lockdown. The absolute daily number of Code Stroke referrals and the portion of patients with stroke mimics remained stable. The portion of female stroke patients decreased (55% to 33%; p = 0.03), and stroke severity as measured by the National Institutes of Health Stroke Scale (median 3 (IQR 0-7) versus 6 (IQR 1-15.5) points; p = 0.04) increased during the lockdown. There was no difference of daily numbers of patients receiving thrombolysis and thrombectomy. CONCLUSIONS: Referral of Code Stroke patients by EMS could be maintained sufficiently despite the COVID-19 pandemic lockdown. However, patients' health care utilization of the EMS may have changed within the public lockdown. EMS remains a useful tool for Code Stroke patient referral during lockdowns, but public education about stroke is required prior to further lockdowns. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/33066900/Code_Stroke_Patient_Referral_by_Emergency_Medical_Services_During_the_Public_COVID_19_Pandemic_Lockdown_ DB - PRIME DP - Unbound Medicine ER -