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Covid-19 HSE Clinical Guidance and Evidence

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Acute / Maternity, Paediatric Hospital Information - Navigation

Stroke remains a medical emergency during the COVID-19 crisis

Stroke remains a medical emergency during the COVID-19 crisis (CD 19-011 001/31.03.20)


Advice of the National Stroke Programme

  • Hospital sites, the HSE and the IHF should continue to encourage patients with FAST+ve symptoms or other acute stroke symptoms to ring 999 immediately, through their communications / websites – ‘urgent care is care as usual’
  • Stroke is a leading cause of death and disability which will occur at the same or greater rate during the COVID-19 outbreak. One early case series suggested a 5% incidence of stroke in a cohort with COVID-19 infection (see https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3550025).
  • Acute stroke is more likely than COVID-19 to cause death or leave you disabled if not treated urgently by a physician trained in stroke and the combination of both conditions may be associated with poorer outcomes, with a 38% mortality reported in one recent series (again see https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3550025).
  • Existing Rapid Access Stroke Prevention / TIA clinics and services need to continue in as far as is practical with established urgent referral pathways for patients with suspected TIAs to enable urgent access to stroke specialist assessment, diagnostic neurovascular work-up and urgent medical treatment or intervention (in cases of severe carotid stenosis while recognising that vascular surgery intervention may not be feasible or safe in the current climate this should be discussed locally) , to prevent stroke and other vascular events.
  • Urgent scanning of acute stroke patients must be prioritised wherever practical because ‘Time is Brain’:
    • The potential risk to stroke patients caused by delays in access to diagnostic CT/ CTA and subsequent acute treatment due to prolonged decontamination of a CT scanner in which a patient with suspected COVID- 19 has just been scanned, is a concern
    • Where hospitals only have a single CT scanner, there should be a rapid cleaning protocol in place (as advised by HSE infection control) to facilitate imaging of all acute stroke patients;
    • Where Hospitals have 2 CT scanners, consideration should be given to scanning COVID-19 cases in one scanner, thus freeing up access to the second scanner for patients with acute stroke and other emergencies;
    • Expert identification, treatment and transfer of patients suitable for mechanical thrombectomy should proceed as usual (code 37 transfers), with accompanying medical / nursing personnel as deemed practical in the current crisis. Repatriation to referring centre will be expected to occur same day and / or as soon as medically possible.
  • Stroke is always a medical emergency and acute stroke unit care prevents death and disability. Stroke Unit beds should retain designation (unless severe clinical pressures dictates otherwise) during the COVID-19 crisis to enable us to best treat stroke and cope with  the  increase in stroke numbers expected during this crisis.
  • Mild-moderate stroke patients should be assessed for suitability for discharge from hospital as soon as possible if they have reliable access to a comprehensive ESD programme. Existing ESD teams and Clinical Nurse Specialists in Stroke should aim to co-ordinate follow-up and encourage ‘therapy-at home’ by remote means (e.g. teleclinics, workbooks, therapy apps) where at all possible to reduce need for face-face therapy in the patient’s home (which should only be undertaken where acceptable to patient and after local risk assessment).

Prof. Ronan Collins National Clinical lead
On behalf of the clinical advisory group of the National Stroke Programme

Health Library Ireland, Health Service Executive. Dr. Steevens' Hospital, Dublin 8. Tel: 01-6352555/8. Email: hli@hse.ie

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