Tanta stroke chain performance during era of COVID-19 pandemic: how to minimize the real/expectation gap

Abstract

Abstract Background During the coronavirus disease of 2019 (COVID-19) pandemic, it would be so difficult to keep the balance between time-saving best stroke care and medical staff safety which obliges healthcare decision-makers to think extraordinarily. The objectives of this study were to evaluate the performance of the Tanta stroke chain (TSC) during the period of the study as well as to identify areas of strength and disparities of the system while dealing with the COVID-19 pandemic measures. The study was conducted on 492 acute ischemic stroke (AIS) patients who were divided into COVID-19 suspected (115 patients) and COVID-19 non-suspected (377 patients). The former group was further COVID-19 confirmed and COVID-19 negative patients. The latter group was subdivided according to the timing of the patient’s arrival at the hospital in the morning, evening, and night shifts group while the fourth group constitute those reached during shifting hours. Patients received early stroke management regarding the 2018 AHA/ASA guideline and its 2019 update. Results Suspected COVID-19 patients represented 23.37% of studied patients. Onset to needle time was significantly prolonged in suspected COVID-19 patients with little chance of utilizing IV thrombolysis (IVT) and consecutive higher morbidity and mortality rates. For COVID-19 non-suspected patients group, a higher rate of IVT utilization was noticed in those reached during the morning shift with a lower chance of utilization in those reached during the shifting hours. Conclusion COVID-19 measures had an inverse effect on TSC logistics which needed upgrading of the service to better cope with the pandemic and to improve AIS patients’ functional outcomes.

Keywords

• Acute ischemic stroke
• COVID-19 pandemic
• Tanta stroke chain
• Stroke chain of survival