Stroke and Vascular Neurology ()

Stroke care during the COVID-19 outbreak in Spain: the experience of Spanish stroke units

  • ,
  • Francisco Purroy,
  • Francisco Moniche,
  • María Alonso de Leciñana,
  • Mar Castellanos,
  • Óscar Ayo-Martín,
  • Ana Morales,
  • María Dolores Fernández Pérez,
  • Esther Gallardo Corral,
  • Patricia Martínez Sánchez,
  • Juan Manuel Oropesa,
  • Soledad Pérez Sánchez,
  • Raul Espinosa Rosso,
  • Jose Antonio Tamayo Toledo,
  • Roberto Valverde Moyano,
  • Carlos Tejero Juste,
  • Herbert Tejada Meza,
  • Elena López-Cancio Martínez,
  • Ignacio Casado Menéndez,
  • M Carmen Jimenez Martinez,
  • Antonio Medina Rodriguez,
  • Juan Carlos López Fernandez,
  • Enrique Jesús Palacio Portilla,
  • Juan Francisco Arenillas Lara,
  • Javier Tejada García,
  • Yolanda Bravo Anguiano,
  • Marta Ferrero Ros,
  • Jose C Segundo Rodriguez,
  • Pere Cardona,
  • Jaume Roquer González,
  • Manuel Jesus Gómez-Choco Cuesta,
  • Joan Marti Fabregas,
  • Joaquín Serena Leal,
  • Sergi Amaro Delgado,
  • Jorge Pagola,
  • Nicolas Lopez Hernandez,
  • Alejandro Ponz De Tienda,
  • Cristina Soriano Soriano,
  • José Tembl Ferrairó,
  • Ignacio Casado Naranjo,
  • Jose M Ramirez Moreno,
  • Jose Luis Maciñeiras Montero,
  • Emilio Rodríguez Castro,
  • Joaquin Carneado Ruiz,
  • Patricia Calleja Castaño,
  • Jose Antonio Egido Herrero,
  • Andres Garcia Pastor,
  • Alicia De Felipe Mimbrera,
  • Araceli García Tejada,
  • Marta Guillán Rodríguez,
  • Laura Izquierdo Esteban,
  • Beatriz Oyanguren Rodeño,
  • Álvaro Ximénez-Carrillo Rico,
  • Cristina Sánchez-Vizcaíno,
  • María Herrera Isasi,
  • Pablo Irimia Sieira,
  • Mar Freijo Guerrero,
  • Maite Martínez Zabaleta,
  • Juan Manuel García Sánchez

DOI
https://doi.org/10.1136/svn-2020-000678

Abstract

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Background and purpose Spain has been heavily affected by COVID-19. Reallocation of resources for managing the outbreak might have caused a disruption in stroke care. This study analyses the impact on stroke care of reorganising the healthcare system in response to the first COVID-19 outbreak peak in Spain and the strategies adopted by Spanish stroke units to deal with this impact.Materials and methods We obtained data from a structured survey sent to the responsible of stroke units across the country. We recorded the number of strokes, stroke code activations, intravenous thrombolysis treatments and mechanical thrombectomies during February and March 2019 and 2020. We also collected information on the impact on workflow metrics and on the availability of specialised neurological care and rehabilitation treatments, the characteristics of stroke care for patients with SARS-CoV-2 infection and the impact on human resources. We compared the activity data between 2019 and 2020 and the information on activity and impact on stroke care between regions classified according to the disease incidence rate.Results Fifty-seven (75%) of all stroke units in Spain responded to the survey. There was an overall reduction in admissions for all stroke types during the outbreak’s peak and in the number of stroke code activations and intravenous thrombolysis treatments, results that were independent of the COVID-19 incidence rate. Participants reported a delay in workflow metrics and a reduction of admissions to stroke units, outpatient clinics and rehabilitation therapies. Specific pathways and protocols for managing stroke patients with SARS-CoV-2 infection have been established.Conclusion The COVID-19 outbreak has jeopardised all phases of stroke care. As a consequence, some patients with stroke did not receive adequate treatment.