Medina-Rioja Raul, González-Calderón Gina, Saldívar-Dávila Sergio, Estrada Saúl Alexander, Gayón-Lombardo Erika, Somerville-Briones Nicole, Calleja-Castillo Juan Manuel
Neurology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico.
Front Neurol. 2022 Apr 6;13:831735. doi: 10.3389/fneur.2022.831735. eCollection 2022.
Stroke is one of the leading causes of death and disability among adults worldwide. The World Health Organization (WHO) officially declared a COVID-19 pandemic on March 11, 2020. The first case in Mexico was confirmed in February 2020, subsequently becoming one of the countries most affected by the pandemic. In 2020, The National Institute of Neurology of Mexico started a Quality assurance program for stroke care, consisting of registering, monitoring and feedback of stroke quality measures through the RES-Q platform. We aim to describe changes in the demand for stroke healthcare assistance at the National Institute of Neurology and Neurosurgery during the pandemic and the behavior of stroke quality metrics during the prepandemic and the pandemic periods. For this study, we analyzed data for acute stroke patients registered in the RES-Q platform, in the prepandemic (November 2019 to February 2020) and pandemic (March-December 2020) periods in two groups, one prior to the pandemic. During the pandemic, there was an increase in the total number of assessed acute stroke patients at our hospital, from 474 to 574. The average time from the onset of symptoms to hospital arrival (Onset to Door Time-OTD) for all stroke patients (thrombolyzed and non-thrombolyzed) increased from 9 h (542 min) to 10.3 h (618.3 min) in the pandemic group. A total of 135 acute stroke patients were enrolled in this registry. We found the following results: Patients in both groups were studied with non-contrast computed tomography (NNCT), computed tomography angiography (CTA), magnetic resonance angiography (MRA), digital subtraction angiography (DSA) or more frequently in the pandemic period (early carotid imaging, Holter monitoring) as needed. Treatment for secondary prevention (antihypertensives, antiplatelets, statins) did not differ. Frequency of performing and documenting the performance of NIHSS scale at arrival and early dysphagia test improved. There was an increase in alteplase use from 21 to 42% ( = 0.03). There was a decrease in door to needle time (46 vs. 39 min = 0.30). After the implementation of a stroke care protocol and quality monitoring system, acute stroke treatment in our institution has gradually improved, a process that was not thwarted during the COVID-19 pandemic.
中风是全球成年人死亡和残疾的主要原因之一。世界卫生组织（WHO）于2020年3月11日正式宣布新冠疫情大流行。墨西哥的首例病例于2020年2月确诊，随后成为受疫情影响最严重的国家之一。2020年，墨西哥国家神经病学研究所启动了一项中风护理质量保证计划，包括通过RES-Q平台对中风质量指标进行登记、监测和反馈。我们旨在描述疫情期间国家神经病学和神经外科研究所中风医疗救助需求的变化，以及疫情前和疫情期间中风质量指标的表现。在本研究中，我们分析了RES-Q平台登记的急性中风患者在疫情前（2019年11月至2020年2月）和疫情期间（2020年3月至12月）两个组的数据，一组在疫情之前。在疫情期间，我院评估的急性中风患者总数有所增加，从474例增至574例。所有中风患者（接受溶栓和未接受溶栓治疗的）从症状发作到入院的平均时间（症状发作到入院时间-OTD）在疫情组从9小时（542分钟）增加到10.3小时（618.3分钟）。共有135例急性中风患者纳入该登记研究。我们发现以下结果：两组患者均接受了非增强计算机断层扫描（NNCT）、计算机断层扫描血管造影（CTA）、磁共振血管造影（MRA）、数字减影血管造影（DSA）检查，或者在疫情期间根据需要更频繁地进行（早期颈动脉成像、动态心电图监测）。二级预防治疗（抗高血压药、抗血小板药、他汀类药物）没有差异。到达时进行美国国立卫生研究院卒中量表（NIHSS）评分及早期吞咽困难测试的频率和记录情况有所改善。阿替普酶的使用比例从21%增加到42%（P = 0.03）。门到针时间有所缩短（46分钟对39分钟，P = 0.30）。在实施中风护理方案和质量监测系统后，我们机构的急性中风治疗逐渐改善，这一过程在新冠疫情期间并未受到阻碍。
