Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands

Faysal Benali; Lotte J. Stolze; Anouk D. Rozeman; Wouter Dinkelaar; Jonathan M. Coutinho; Bart J. Emmer; Rob A.R. Gons; Lonneke F.S. Yo; Julia H. van Tuijl; Issam Boukrab; Dianne H.K. van Dam-Nolen; Ido R. van den Wijngaard; Geert J. Lycklama à Nijeholt; Karlijn F. de Laat; Lukas C. van Dijk; Heleen M. den Hertog; H. Zwenneke Flach; Marieke J.H. Wermer; Marianne A.A. van Walderveen; Paul J.A.M. Brouwers; Tomas Bulut; Sarah E. Vermeer; Marie Louise E. Bernsen; Maarten Uyttenboogaart; Reinoud P.H. Bokkers; Jeroen D. Boogaarts; Frank Erik de Leeuw; H. Bart van der Worp; Irene C. van der Schaaf; Wouter J. Schonewille; Jan A. Vos; Michel J.M. Remmers; Farshad Imani; Diederik W.J. Dippel; Wim H. van Zwam; Paul J. Nederkoorn; Robert J. van Oostenbrugge

doi:10.1186/s12883-021-02539-4

Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands

Faysal Benali^*, Lotte J. Stolze, Anouk D. Rozeman, Wouter Dinkelaar, Jonathan M. Coutinho, Bart J. Emmer, Rob A.R. Gons, Lonneke F.S. Yo, Julia H. van Tuijl, Issam Boukrab, Dianne H.K. van Dam-Nolen, Ido R. van den Wijngaard, Geert J. Lycklama à Nijeholt, Karlijn F. de Laat, Lukas C. van Dijk, Heleen M. den Hertog, H. Zwenneke Flach, Marieke J.H. Wermer, Marianne A.A. van Walderveen, Paul J.A.M. BrouwersTomas Bulut, Sarah E. Vermeer, Marie Louise E. Bernsen, Maarten Uyttenboogaart, Reinoud P.H. Bokkers, Jeroen D. Boogaarts, Frank Erik de Leeuw, H. Bart van der Worp, Irene C. van der Schaaf, Wouter J. Schonewille, Jan A. Vos, Michel J.M. Remmers, Farshad Imani, Diederik W.J. Dippel, Wim H. van Zwam, Paul J. Nederkoorn, Robert J. van Oostenbrugge

^*Corresponding author for this work

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Abstract

Introduction: We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. Methods: We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. Results: A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. Conclusions: During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.

Original language	English
Article number	22
Journal	BMC Neurology
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s12883-021-02539-4
Publication status	Published - 11 Jan 2022

Bibliographical note

Funding Information:
Diederik WJ Dippel: Reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution.

Funding Information:
Frank-Erik de Leeuw: supported by a clinical established investigator grant of the Dutch Heart Foundation (grant 2014 T060), and by a VIDI innovational grant from The Netherlands Organization for Health Research and Development, ZonMw (grant 016126351). Furthermore, he is associate editor of the International Journal of Stroke.
H Bart van der Worp: received consultancy fees paid to his institution from Bayer and Boehringer Ingelheim.

Paul J Nederkoorn: Chair clinical audit board Dutch Acute Stroke Audit (DASA).

Wim H van Zwam: Speaker’s fees from Cerenovus and Stryker, paid to institution.

Publisher Copyright:
© 2022, The Author(s).

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Benali, F., Stolze, L. J., Rozeman, A. D., Dinkelaar, W., Coutinho, J. M., Emmer, B. J., Gons, R. A. R., Yo, L. F. S., van Tuijl, J. H., Boukrab, I., van Dam-Nolen, D. H. K., van den Wijngaard, I. R., Lycklama à Nijeholt, G. J., de Laat, K. F., van Dijk, L. C., den Hertog, H. M., Flach, H. Z., Wermer, M. J. H., van Walderveen, M. A. A., ... van Oostenbrugge, R. J. (2022). Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands. BMC Neurology, 22(1), [22]. https://doi.org/10.1186/s12883-021-02539-4

@article{a2f8c22b9e8f4293a8d1c11e5bbe7d4d,

title = "Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands",

abstract = "Introduction: We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. Methods: We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. Results: A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. Conclusions: During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.",

author = "Faysal Benali and Stolze, {Lotte J.} and Rozeman, {Anouk D.} and Wouter Dinkelaar and Coutinho, {Jonathan M.} and Emmer, {Bart J.} and Gons, {Rob A.R.} and Yo, {Lonneke F.S.} and {van Tuijl}, {Julia H.} and Issam Boukrab and {van Dam-Nolen}, {Dianne H.K.} and {van den Wijngaard}, {Ido R.} and {Lycklama {\`a} Nijeholt}, {Geert J.} and {de Laat}, {Karlijn F.} and {van Dijk}, {Lukas C.} and {den Hertog}, {Heleen M.} and Flach, {H. Zwenneke} and Wermer, {Marieke J.H.} and {van Walderveen}, {Marianne A.A.} and Brouwers, {Paul J.A.M.} and Tomas Bulut and Vermeer, {Sarah E.} and Bernsen, {Marie Louise E.} and Maarten Uyttenboogaart and Bokkers, {Reinoud P.H.} and Boogaarts, {Jeroen D.} and {de Leeuw}, {Frank Erik} and {van der Worp}, {H. Bart} and {van der Schaaf}, {Irene C.} and Schonewille, {Wouter J.} and Vos, {Jan A.} and Remmers, {Michel J.M.} and Farshad Imani and Dippel, {Diederik W.J.} and {van Zwam}, {Wim H.} and Nederkoorn, {Paul J.} and {van Oostenbrugge}, {Robert J.}",

note = "Funding Information: Diederik WJ Dippel: Reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. Funding Information: Frank-Erik de Leeuw: supported by a clinical established investigator grant of the Dutch Heart Foundation (grant 2014 T060), and by a VIDI innovational grant from The Netherlands Organization for Health Research and Development, ZonMw (grant 016126351). Furthermore, he is associate editor of the International Journal of Stroke. H Bart van der Worp: received consultancy fees paid to his institution from Bayer and Boehringer Ingelheim. Paul J Nederkoorn: Chair clinical audit board Dutch Acute Stroke Audit (DASA). Wim H van Zwam: Speaker{\textquoteright}s fees from Cerenovus and Stryker, paid to institution. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = jan,

day = "11",

doi = "10.1186/s12883-021-02539-4",

language = "English",

volume = "22",

journal = "BMC Neurology",

issn = "1471-2377",

publisher = "BioMed Central Ltd.",

number = "1",

}

Benali, F, Stolze, LJ, Rozeman, AD, Dinkelaar, W, Coutinho, JM, Emmer, BJ, Gons, RAR, Yo, LFS, van Tuijl, JH, Boukrab, I, van Dam-Nolen, DHK, van den Wijngaard, IR, Lycklama à Nijeholt, GJ, de Laat, KF, van Dijk, LC, den Hertog, HM, Flach, HZ, Wermer, MJH, van Walderveen, MAA, Brouwers, PJAM, Bulut, T, Vermeer, SE, Bernsen, MLE, Uyttenboogaart, M, Bokkers, RPH, Boogaarts, JD, de Leeuw, FE, van der Worp, HB, van der Schaaf, IC, Schonewille, WJ, Vos, JA, Remmers, MJM, Imani, F, Dippel, DWJ, van Zwam, WH, Nederkoorn, PJ & van Oostenbrugge, RJ 2022, 'Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands', BMC Neurology, vol. 22, no. 1, 22. https://doi.org/10.1186/s12883-021-02539-4

TY - JOUR

T1 - Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands

AU - Benali, Faysal

AU - Stolze, Lotte J.

AU - Rozeman, Anouk D.

AU - Dinkelaar, Wouter

AU - Coutinho, Jonathan M.

AU - Emmer, Bart J.

AU - Gons, Rob A.R.

AU - Yo, Lonneke F.S.

AU - van Tuijl, Julia H.

AU - Boukrab, Issam

AU - van Dam-Nolen, Dianne H.K.

AU - van den Wijngaard, Ido R.

AU - Lycklama à Nijeholt, Geert J.

AU - de Laat, Karlijn F.

AU - van Dijk, Lukas C.

AU - den Hertog, Heleen M.

AU - Flach, H. Zwenneke

AU - Wermer, Marieke J.H.

AU - van Walderveen, Marianne A.A.

AU - Brouwers, Paul J.A.M.

AU - Bulut, Tomas

AU - Vermeer, Sarah E.

AU - Bernsen, Marie Louise E.

AU - Uyttenboogaart, Maarten

AU - Bokkers, Reinoud P.H.

AU - Boogaarts, Jeroen D.

AU - de Leeuw, Frank Erik

AU - van der Worp, H. Bart

AU - van der Schaaf, Irene C.

AU - Schonewille, Wouter J.

AU - Vos, Jan A.

AU - Remmers, Michel J.M.

AU - Imani, Farshad

AU - Dippel, Diederik W.J.

AU - van Zwam, Wim H.

AU - Nederkoorn, Paul J.

AU - van Oostenbrugge, Robert J.

N1 - Funding Information: Diederik WJ Dippel: Reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. Funding Information: Frank-Erik de Leeuw: supported by a clinical established investigator grant of the Dutch Heart Foundation (grant 2014 T060), and by a VIDI innovational grant from The Netherlands Organization for Health Research and Development, ZonMw (grant 016126351). Furthermore, he is associate editor of the International Journal of Stroke. H Bart van der Worp: received consultancy fees paid to his institution from Bayer and Boehringer Ingelheim. Paul J Nederkoorn: Chair clinical audit board Dutch Acute Stroke Audit (DASA). Wim H van Zwam: Speaker’s fees from Cerenovus and Stryker, paid to institution. Publisher Copyright: © 2022, The Author(s).

PY - 2022/1/11

Y1 - 2022/1/11

N2 - Introduction: We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. Methods: We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. Results: A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. Conclusions: During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.

AB - Introduction: We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. Methods: We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. Results: A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. Conclusions: During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.

UR - http://www.scopus.com/inward/record.url?scp=85122835637&partnerID=8YFLogxK

U2 - 10.1186/s12883-021-02539-4

DO - 10.1186/s12883-021-02539-4

M3 - Article

AN - SCOPUS:85122835637

VL - 22

JO - BMC Neurology

JF - BMC Neurology

SN - 1471-2377

IS - 1

M1 - 22

ER -

Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands

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