Maintaining acute stroke care during the covid-19 pandemic: The Tuscany stroke network performance in 2020

Background and aims The COVID 19 pandemic is impacting on acute ischemic stroke (AIS) care: fewer patients reach the hospital within the therapeutic time-window. We aim at describing and quantifying this impact in terms of number of stroke hospital admissions and treatments across the Tuscany Stroke Network (TSN) in 2020. Methods The TSN was implemented in 2015 and it is structured as three hub-and-spoke systems throughout Tuscany. We retrospectively included all AIS patients admitted and those treated in each of the 22 TSN hospitals during 2020, using the 2019 as a comparator. Results From January 1 through December 312,020, a total of 1388 treatments were administered to AIS patients, being 1536 during the same period of 2019. Compared with 2019, AIS hospital admissions in 2020 decreased by 11.7% while reperfusion treatments only by 9.5%. In particular, thrombolysis decreased by 10% but endovascular tratments increased by 11.7%. Single month as well as single hospital performances varied a lot. Conclusions During 2020, secondary to stay-at-home orders and possibly patients wanting to avoid healthcare facilities, stroke volumes decreased significantly across Tuscany. In addition, many patients reached hospitals beyond thrombolysis therapeutic window and were transferred to the hub for endovascular treatment. The logistic interventions provided by the TSN counterbalanced the deleterious effects of the COVID 19 outbreak on AIS care. Our data suggest both the need and the benefit of organized stroke systems. Only a well established hospital network can adjust its organization and logistics to quickly and effectively deal with an unexpected health problem