Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain.

BACKGROUND AND PURPOSE: Spain has been one of the countries more heavily stricken by SARS-CoV-2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID-19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. METHODS: This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra- and intra-hospital times of action, Code Stroke activation pathway, COVID-19 status, reperfusion rate, and short-term outcome before and after the setting of the emergency state were analysed. RESULTS: A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out-of-hospital (95.0 vs. 110.0 min, P = 0.001) and door-to-needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID-19 patients had more in-hospital mortality. CONCLUSION: A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out-of-hospital and door-to-needle times and worse reperfusion rates in northwest Spain. COVID-19 patients had more in-hospital mortality.

Analysis of the prognostic value of emergency blood tests in ischaemic stroke.

OBJECTIVES: This study aims to evaluate the prognostic value of emergency blood test results in patients with acute ischaemic stroke. METHODS: We evaluated 592 prospectively patients with neuroimaging-confirmed ischaemic stroke admitted to our stroke unit between 2015 and 2018. We gathered emergency blood test results and calculated the neutrophil-to-lymphocyte ratio and the neutrophil-to-platelet ratio (neutrophils × 1.000/platelets). The association between blood test results and functional prognosis (as measured with the modified Rankin Scale) and such complications as haemorrhagic transformation was evaluated by logistic regression analysis. The additional predictive value of blood test parameters was assessed with receiver operating characteristic curves and the net reclassification index. RESULTS: An neutrophil-to-lymphocyte ratio ≥ 3 at admission was associated with a two-fold increase in the risk of functional dependence at 3 months (OR: 2.24; 95% CI: 1.35-3.71) and haemorrhagic transformation (OR: 2.11; 95% CI: 1.09-4.05), while an neutrophil-to-lymphocyte ratio ≥ 3.86 resulted in an increase of 2.4 times in the risk of mortality at 3 months (OR: 2.41; 95% CI: 1.37-4.26) after adjusting for the traditional predictors of poor outcomes. Patients with neutrophil-to-platelet ratio ≥ 32 presented 3 times more risk of haemorrhagic transformation (OR: 3.17; 95% CI: 1.70-5.92) and mortality at 3 months (OR: 3.07; 95% CI: 1.69-5.57). Adding these laboratory parameters to standard clinical-radiological models significantly improved discrimination and prognostic accuracy. CONCLUSIONS: Basic blood test parameters provide important prognostic information for stroke patients and should therefore be analysed in combination with standard clinical and radiological parameters to optimise ischaemic stroke management.

[Impact of the COVID-19 pandemic on the training of Spanish neurology residents]. / Repercusión de la pandemia por COVID-19 en la formación de los residentes de neurología españoles.

Introduction: The COVID-19 pandemic has transformed medical practice and severely disrupted the training of medical residents worldwide. The Spanish Society of Neurology conducted a study to assess its impact on the training of neurology residents in Spain. Methods: We performed a descriptive, cross-sectional study through a survey distributed by e-mail to all neurology residents belonging to the Society. The survey included questions on demographic variables, care activity, and personal and educational impact of the pandemic, as well as respondents' expectations for the future of their work in the post-pandemic era. Results: Of 422 surveys sent, we received a total of 152 responses (36%); 79 respondents (52%) were women and 73 (48%) were men. By year of residency, 51 respondents (33.6%) were in the fourth year, 45 (29.6%) in the third year, 28 (18.4%) in the second year, and 28 (18.4%) in the first year. A total of 139 respondents (90.8%) reported changes in hospital activity, and 126 (82.8%) considered the situation to have had a negative impact on their training, with 99 (64.7%) having lost non-recoverable rotations. Sixty-six percent of respondents (n=101) expressed a desire to extend their residency period. Conclusions: The pandemic has had an extremely severe impact on all areas of the health system, with trainee physicians being one of the most affected groups. Among neurology residents, the crisis has caused significant shortcomings in their training and clinical activities, through the suspension of specific rotations. A high percentage of respondents wished to extend the residency period.

[Characteristics of the stroke alert process attended by 061 ARAGON assistance units from 2010 to 2016. Factors influencing times of response and access to fibrinolytic treatment]. / Casuística de códigos ictus atendidos por 061 ARAGÓN en el período 2010-2016. Factores que influyen en los tiempos de respuesta y de acceso a la fibrinólisis.

AIM: To study the response times of stroke code assistance by care units of 061 ARAGON, analyzing factors involved and their relationship with availability to fibrinolytic treatment in the hyperacute phase. PATIENTS AND METHODS: Transversal descriptive study on outpatient care from the registry of cases attended by 061 ARAGON health care units to patients with stroke code during the period 2010-2016. RESULTS: A total of 1743 patients were attended (54.6% males), with a mean age of 72.83 ± 13.1 years. There was a higher number of strokes attended in 2015 and 2016 (372 and 366 respectively), compared to the average of 201 strokes per year in the rest of the years. 27,2% of patients were treated between 08:00-11:59 h, the most frequent time interval. Regarding the time, it took to take care of the patient, the average was 71.93 ± 33.64 minutes with a longer response time in Teruel. When influence of the hour interval on the percentage of cases treated with fibrinolysis was analyzed, a higher rate of fibrinolysis was observed when it was activated between 12:00-15:59 h (28.1%). CONCLUSIONS: In 55,3% of patients, the 061 response time was greater than 60 minutes, but this time were not conditioned by the activation time. However, there were differences in the percentage of cases fibrinolysed in the different time intervals, suggesting that factors other than the response time of 061 influence the indication of fibrinolytic treatment.

TITLE: Casuística de códigos ictus atendidos por 061 ARAGÓN en el período 2010-2016. Factores que influyen en los tiempos de respuesta y de acceso a la fibrinólisis.Objetivo. Estudiar los tiempos de respuesta en la atención al código ictus por unidades asistenciales del 061 ARAGÓN, analizando los factores implicados y su relación con el acceso al tratamiento fibrinolítico en la fase hiperaguda. Pacientes y métodos. Estudio descriptivo transversal sobre la asistencia extrahospitalaria a partir del registro de casos atendidos por unidades asistenciales del 061 ARAGÓN a pacientes con código ictus durante el período 2010-2016. Resultados. Se recogieron 1.743 pacientes con código ictus (54,6%, varones), con una edad media de 72,83 ± 13,1 años. El número de ictus atendidos en 2015 y 2016 (372 y 366, respectivamente) fue mayor que la media de 201 ictus anuales en el resto de los años. El 27,2% de los pacientes fueron atendidos entre las 08:00 y las 11:59 h, intervalo horario con mayor frecuentación. Respecto al tiempo que se tardó en atender al paciente, la media fue de 71,93 ± 33,64 minutos, con ma­yor tiempo de respuesta en Teruel. Cuando se analizó la influencia del intervalo horario sobre el porcentaje de casos tratados con fibrinólisis, se observó una mayor tasa de fibrinólisis cuando se activó entre las 12:00 y las 15:59 h (28,1%). Conclusión. En el 55,3% de los pacientes, el tiempo de respuesta del 061 fue mayor de 60 minutos, pero este tiempo no se vio condicionado por la hora de activación. Sin embargo, sí había diferencias en el porcentaje de casos de fibrinólisis en los diferentes intervalos horarios, lo que sugiere que factores distintos al tiempo de respuesta del 061 influyen en la indicación del tratamiento fibrinolítico.