Reader response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
MarceleSchettini, Neurologist, Hospital das Clínicas, University of São Paulo, Brazil
AdalbertoStudart, Neurologist, Hospital das Clínicas, University of São Paulo, Brazil
Adriana BastosConforto, Neurologist - PhD, Hospital das Clínicas, University of São Paulo, Brazil
Submitted June 01, 2020
We read with interest the article by Dr. Leira et al.1 They suggest measures for care of patients with acute stroke during the COVID-19 pandemic. We would like to share the preliminary experience of the largest hospital in Latin America.
The hospital consists of eight specialized institutes for tertiary care, two hospitals for secondary care, and has a total of 2,400 beds. A stroke code protocol was implemented in 2014. During the COVID-19 pandemic, it was decided that all beds in the Central Institute would be devoted to care of infected patients, based on the premise that in-hospital isolation of infected patients is an important measure to reduce nosocomial spread.2,3 On March 30, all patients without coronavirus infection were transferred to other institutes.
The neurology emergency room was transferred into a non-COVID emergency room at the Heart Institute, some neurologists were reassigned, and the stroke code protocol was reshaped over one week.
On March 30, a patient eligible for mechanical thrombectomy according to DAWN criteria4 was successfully treated at the new institute. Her NIHSS score was 11 upon admission and dropped to 1 24 hours later.
This case illustrates that implementation of changes in a stroke code protocol are feasible, even in a developing country.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Leira EC, Russman AN, Biller J, et al. Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions. Neurology May 2020 Epub May 8.
Li Q, Guan X, Wu P et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199–1207.
Wee LE, Conceicao EP, Sim XYJ, et al. Minimising intra-hospital transmission of COVID-19: the role of social distancing. J Hosp Infect 2020;105:113–115.
Nogueira RG, Jadhav AP, Haussen DC et al. Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct. N Engl J Med 2018;378:11–21.
We read with interest the article by Dr. Leira et al.1 They suggest measures for care of patients with acute stroke during the COVID-19 pandemic. We would like to share the preliminary experience of the largest hospital in Latin America.
The hospital consists of eight specialized institutes for tertiary care, two hospitals for secondary care, and has a total of 2,400 beds. A stroke code protocol was implemented in 2014. During the COVID-19 pandemic, it was decided that all beds in the Central Institute would be devoted to care of infected patients, based on the premise that in-hospital isolation of infected patients is an important measure to reduce nosocomial spread.2,3 On March 30, all patients without coronavirus infection were transferred to other institutes.
The neurology emergency room was transferred into a non-COVID emergency room at the Heart Institute, some neurologists were reassigned, and the stroke code protocol was reshaped over one week.
On March 30, a patient eligible for mechanical thrombectomy according to DAWN criteria4 was successfully treated at the new institute. Her NIHSS score was 11 upon admission and dropped to 1 24 hours later.
This case illustrates that implementation of changes in a stroke code protocol are feasible, even in a developing country.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References