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Title: Impact of the COVID-19 pandemic on hyperacute stroke treatment: experience from a comprehensive stroke centre in Singapore
Authors: Paliwal, Prakash R 
Tan, Benjamin YQ
Leow, Aloysius ST
Sibi, Sunny
Chor, Daniel WP
Chin, Amanda XY
Yau, Ying-Wei 
Cross, Gail B 
Wong, Lily YH
Chia, Magdalene LJ
Quak, Zhixuan
Chua, Christopher YK
Tang, David KK
Zune, Ei The
Hung, Jennifer
Goh, Yihui
Jing, Mingxue
Gopinathan, Anil
Yang, Cunli
Ahmad, Aftab
Khoo, Deborah XL
Lee, Chang-Chuan M
Seet, Raymond CS 
Sharma, Vijay K 
Teoh, Hock-Luen 
Yeo, Leonard LL 
Chan, Bernard PL
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Peripheral Vascular Disease
Cardiovascular System & Cardiology
Acute ischaemic stroke
Stroke activation
Recanalization therapy
Issue Date: 13-Jul-2020
Publisher: SPRINGER
Citation: Paliwal, Prakash R, Tan, Benjamin YQ, Leow, Aloysius ST, Sibi, Sunny, Chor, Daniel WP, Chin, Amanda XY, Yau, Ying-Wei, Cross, Gail B, Wong, Lily YH, Chia, Magdalene LJ, Quak, Zhixuan, Chua, Christopher YK, Tang, David KK, Zune, Ei The, Hung, Jennifer, Goh, Yihui, Jing, Mingxue, Gopinathan, Anil, Yang, Cunli, Ahmad, Aftab, Khoo, Deborah XL, Lee, Chang-Chuan M, Seet, Raymond CS, Sharma, Vijay K, Teoh, Hock-Luen, Yeo, Leonard LL, Chan, Bernard PL (2020-07-13). Impact of the COVID-19 pandemic on hyperacute stroke treatment: experience from a comprehensive stroke centre in Singapore. JOURNAL OF THROMBOSIS AND THROMBOLYSIS 50 (3) : 596-603. ScholarBank@NUS Repository.
Abstract: The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p = 0.004, 95% CI 6.513 to − 2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable (p = 0.519, 95% CI − 1.605 to 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 h (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.
ISSN: 09295305
DOI: 10.1007/s11239-020-02225-1
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