Masouris Ilias, Kellert L, Müller R, Fuhry L, Hamann G F, Rémi J M, Schöberl F
Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany.
Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany.
J Neurol. 2024 Sep;271(9):6045-6055. doi: 10.1007/s00415-024-12578-9. Epub 2024 Jul 20.
The COVID-19 pandemic had significant impact on global healthcare, including stroke management. Telemedical stroke networks have emerged with positive results for patient outcome in rural areas without stroke expertise. However, telestroke faced enormous on-site challenges during the pandemic. So far, data on performance and clinical outcomes in telestroke settings during the COVID-pandemic are scarce.
We retrospectively analyzed data from stroke patients treated in four spoke hospitals of the Bavarian telestroke network NEVAS in 2020-2021 and 2019 as reference year and compared the 3 years for various parameters. Primary outcome was functional outcome according to the modified Rankin scale (mRS). Secondary outcome parameters included time intervals, periprocedural intracranial hemorrhage rates, and mortality.
In 2019-2021, 2820 patients were treated for acute ischemic stroke with an admission decrease of 10% during the pandemic. Of those, 241 received only IVT and 204 were transferred to our center for MT. Door-to-imaging, door-to-needle, and symptom-onset-to-groin times remained comparable in the 3 years. Complication rates remained at a low level. Good clinical outcome rates (mRS 0-2) at discharge remained stable for all stroke patients (82-84%) and for those treated with IVT (64-77%). Good clinical outcome rates at 3 month follow-up for MT patients declined in 2020 (23% vs. 35% in 2019) but recovered again in 2021 (42%). Mortality rates did not increase for all patient groups analyzed.
Stroke care remained robust during the COVID-pandemic within our network, indicating that well-established telestroke networks can overcome unexpected critical challenges such as a pandemic, guaranteeing best practice stroke care in rural areas.
新型冠状病毒肺炎（COVID-19）大流行对全球医疗保健产生了重大影响，包括卒中管理。远程医疗卒中网络已出现，并在没有卒中专业知识的农村地区对患者预后产生了积极效果。然而，在大流行期间，远程卒中面临着巨大的现场挑战。到目前为止，关于COVID-19大流行期间远程卒中环境中的性能和临床结果的数据很少。
我们回顾性分析了2020 - 2021年在巴伐利亚远程卒中网络NEVAS的四家分支医院接受治疗的卒中患者的数据，并将2019年作为参考年份，比较了这三年的各种参数。主要结局是根据改良Rankin量表（mRS）评估的功能结局。次要结局参数包括时间间隔、围手术期颅内出血率和死亡率。
在2019 - 2021年期间，2820例患者接受了急性缺血性卒中治疗，在大流行期间入院人数减少了10%。其中，241例仅接受了静脉溶栓治疗（IVT），204例被转至我们中心进行机械取栓治疗（MT）。三年来，从就诊到影像学检查、从就诊到穿刺以及从症状发作到股动脉穿刺的时间保持可比。并发症发生率维持在较低水平。所有卒中患者出院时良好临床结局率（mRS 0 - 2）保持稳定（82% - 84%），接受IVT治疗的患者也是如此（64% - 77%）。MT患者在3个月随访时的良好临床结局率在2020年有所下降（23% vs. 2019年的35%），但在2021年又恢复（42%）。所有分析的患者组死亡率均未增加。
在我们的网络中，COVID-19大流行期间卒中护理保持稳健，这表明成熟的远程卒中网络可以克服诸如大流行等意想不到的严峻挑战，确保农村地区的最佳卒中护理实践。
