Medical emergency team interventions to suspected stroke and stroke mortality during the COVID-19 pandemic in Poland
Abstract
Introduction: Stroke is a major medical, economic and social problem. It is one of the leading causes of
death worldwide in developed and highly developed countries. The most important extra-medical factor
in stroke treatment is time. This study aimed to analyse interventions of emergency medical teams (EMT)
to suspected stroke cases during the COVID-19 pandemic and determine the mortality rate of the patients
in question.
Material and methods: The data come from nationwide IT systems. Data from April 2019 to December
2021 were analysed. A total of 8,801,083 interventions were reported throughout the period. The criterion
for inclusion of medical interventions in this study was the diagnosis of stroke (ICD-10: I60–I64) given to
patients by an EMT leader. A total of 142,730 interventions met this criterion. Microdata, pseudonymized
with a common key, allowed to monitor the patients from the EMT call through hospital admission to death.
Results: In April–December 2020 and April–December 2021 more interventions were reported, compared
to the same period in 2019. The number of hospitalizations with a diagnosis of stroke (ICD-10: I60–I64)
was significantly lower in the second and fourth quarters of 2020. From the beginning of the pandemic,
there was a marked increase in the time taken for EMTs to intervene. Death rates increased during the
pandemic period.
Conclusions: There were fewer hospital admissions due to stroke in 2020–2021 compared to the same
period in 2019. During the COVID-19 pandemic in Poland, the reported 1-year stroke mortality was
significantly higher which might have been caused by multiple reasons including medical, system and
socio-behavioural, or combined.
Keywords: COVID-19emergency medical teamstrokemortality
References
- Maluchnik M, Ryglewicz D, Sienkiewicz-Jarosz H, et al. Differences in acute ischaemic stroke care in Poland: analysis of claims database of National Health Fund in 2017. Neurol Neurochir Pol. 2020; 54(5): 449–455.
- Jermakow N, Maluchnik M, Sienkiewicz-Jarosz H, et al. Trends of stroke hospitalisation and fatality rates in young vs. elderly people in Poland during 2010-2019 decade. Neurol Neurochir Pol. 2022; 56(5): 417–427.
- Fassbender K, Walter S, Grunwald IQ, et al. Prehospital stroke management in the thrombectomy era. Lancet Neurol. 2020; 19(7): 601–610.
- Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019; 50(12): e344–e418.
- Walter S, Audebert HJ, Katsanos AH, et al. European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management. Eur Stroke J. 2022; 7(1): XXVII–LIX.
- Bugge HF, Guterud M, Bache KCG, et al. Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) study protocol: a stepped wedge randomised trial of stroke screening using the National Institutes of Health Stroke Scale in the ambulance. Trials. 2022; 23(1): 113.
- Fladt J, Meier N, Thilemann S, et al. Reasons for prehospital delay in acute ischemic stroke. J Am Heart Assoc. 2019; 8(20): e013101.
- Kandimalla J, Vellipuram AR, Rodriguez G, et al. Role of Telemedicine in Prehospital Stroke Care. Curr Cardiol Rep. 2021; 23(6): 71.
- Magnusson C, Herlitz J, Sunnerhagen KS, et al. Prehospital recognition of stroke is associated with a lower risk of death. Acta Neurol Scand. 2022; 146(2): 126–136.
- Kharbach A, Obtel M, Achbani A, et al. Ischemic stroke in Morocco: prehospital delay and associated factors. Rev Epidemiol Sante Publique. 2021; 69(6): 345–359.
- Ganesh A, Stang JM, McAlister FA, et al. Changes in ischemic stroke presentations, management and outcomes during the first year of the COVID-19 pandemic in Alberta: a population study. CMAJ. 2022; 194(12): E444–E455.
- Seo AhR, Lee WJ, Woo SH, et al. Pre-Hospital delay in patients with acute stroke during the initial phase of the coronavirus disease 2019 outbreak. J Korean Med Sci. 2022; 37(6): e47.
- Montaner J, Barragán-Prieto A, Pérez-Sánchez S, et al. Break in the stroke chain of survival due to COVID-19. Stroke. 2020; 51(8): 2307–2314.
- Larsen K, Hov MR, Sandset EC. Prehospital stroke scales — the need for a gold standard in the field. Acta Neurol Scand. 2022; 145(3): 263–264.
- Liczba zgonów zarejestrowanych w Rejestrze Stanu Cywilnego — otwarte dane. https://dane.gov.pl/en/dataset/1953,liczba-zgonow-zarejestrowanych-w-rejestrze-stanu-cywilnego (07.04.2022).
- https://basiw.mz.gov.pl/index.html#/visualization?id=3400 (07.04.2022).
- Potisopha W, Vuckovic KM, DeVon HA, et al. Sex differences in prehospital delay in patients with acute stroke: a systematic review. J Cardiovasc Nurs. 2020; 35(6): E77–E88.
- Bersano A, Kraemer M, Touzé E, et al. Stroke care during the COVID-19 pandemic: experience from three large European countries. Eur J Neurol. 2020; 27(9): 1794–1800.
- Esenwa C, Parides MK, Labovitz DL. The effect of COVID-19 on stroke hospitalizations in New York City. J Stroke Cerebrovasc Dis. 2020; 29(10): 105114.
- Romoli M, Eusebi P, Forlivesi S, et al. Stroke network performance during the first COVID-19 pandemic stage: A meta-analysis based on stroke network models. Int J Stroke. 2021; 16(7): 771–783.
- Richter D, Eyding J, Weber R, et al. Analysis of nationwide stroke patient care in times of COVID-19 pandemic in germany. Stroke. 2021; 52(2): 716–721.
- de Havenon A, Yaghi S, Majersik JJ, et al. Acute coronary syndrome and ischemic stroke discharges in the united states during the COVID-19 pandemic. Stroke. 2021; 52(6): e239–e241.
- Kristoffersen ES, Jahr SH, Thommessen B, et al. Effect of COVID-19 pandemic on stroke admission rates in a Norwegian population. Acta Neurol Scand. 2020; 142(6): 632–636.
- Katsanos AH, Palaiodimou L, Zand R, et al. Changes in stroke hospital care during the COVID-19 pandemic: a systematic review and meta-analysis. Stroke. 2021; 52(11): 3651–3660.
- Bres Bullrich M, Fridman S, Mandzia JL, et al. COVID-19: stroke admissions, emergency department visits, and prevention clinic referrals. Can J Neurol Sci. 2020; 47(5): 693–696.
- Bersano A, Kraemer M, Touzé E, et al. Stroke care during the COVID-19 pandemic: experience from three large European countries. Eur J Neurol. 2020; 27(9): 1794–1800.
- Douiri A, Muruet W, Bhalla A, et al. Stroke care in the united kingdom during the COVID-19 pandemic. Stroke. 2021; 52(6): 2125–2133.
- Uchino K, Kolikonda MK, Brown D, et al. Decline in stroke presentations during COVID-19 surge. Stroke. 2020; 51(8): 2544–2547.
- Altersberger VL, Stolze LJ, Heldner MR, et al. Maintenance of acute stroke care service during the COVID-19 pandemic lockdown. Stroke. 2021; 52(5): 1693–1701.
- Diegoli H, Magalhães PSC, Martins SC, et al. Decrease in hospital admissions for transient ischemic attack, mild, and moderate stroke during the COVID-19 era. Stroke. 2020; 51(8): 2315–2321.
- Gdovinová Z, Vitková M, Baráková A, et al. The impact of the COVID-19 outbreak on acute stroke care in Slovakia: Data from across the country. Eur J Neurol. 2021; 28(10): 3263–3266.
- Nogueira RG, Qureshi MM, Abdalkader M, et al. Global impact of COVID-19 on stroke care and IV thrombolysis. Neurology. 2021; 96(23): e2824–e2838.
- Sedova P, Kent JA, Bryndziar T, et al. The decline in stroke hospitalization due to COVID-19 is unrelated to COVID-19 intensity. Eur J Neurol. 2023; 30(4): 943–950.
- Gunnarsson K, Tofiq A, Mathew A, et al. Changes in stroke and TIA admissions during the COVID-19 pandemic: a meta-analysis. Eur Stroke J. 2023 [Epub ahead of print]: 23969873231204127.
- Belani P, Schefflein J, Kihira S, et al. COVID-19 is an independent risk factor for acute ischemic stroke. AJNR Am J Neuroradiol. 2020; 41(8): 1361–1364.
- Dula A, Brown GG, Aggarwal A, et al. Decrease in stroke diagnoses during the COVID-19 pandemic: where did all our stroke patients go? JMIR Aging. 2020; 3(2): e21608.