Stroke Systems of Care During the COVID-19 Epidemic in Kobe City

Nobuyuki Ohara; Hirotoshi Imamura; Hidemitsu Adachi; Yoshie Hara; Kohkichi Hosoda; Hidehito Kimura; Kazuyuki Kuwayama; Takashi Mizowaki; Yasuhiko Motooka; Kazuya Nakashima; Narihide Shinoda; Takeshi Takamoto; Yasushi Ueno; Ikuya Yamaura; Chie Yanagihara; Yasuhisa Yoshida; Michi Kawamoto; Nobuyuki Sakai

doi:10.1016/j.jstrokecerebrovasdis.2020.105343

Stroke Systems of Care During the COVID-19 Epidemic in Kobe City

J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105343. doi: 10.1016/j.jstrokecerebrovasdis.2020.105343. Epub 2020 Sep 30.

Authors

Nobuyuki Ohara¹, Hirotoshi Imamura², Hidemitsu Adachi³, Yoshie Hara⁴, Kohkichi Hosoda⁵, Hidehito Kimura⁶, Kazuyuki Kuwayama⁷, Takashi Mizowaki⁸, Yasuhiko Motooka⁹, Kazuya Nakashima¹⁰, Narihide Shinoda¹¹, Takeshi Takamoto¹², Yasushi Ueno¹³, Ikuya Yamaura¹⁴, Chie Yanagihara¹⁵, Yasuhisa Yoshida¹⁶, Michi Kawamoto¹⁷, Nobuyuki Sakai¹⁸

Affiliations

¹ Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan. Electronic address: nobuyuki.ohara@gmail.com.
² Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan. Electronic address: i-hiro@zg7.so-net.ne.jp.
³ Department of Neurosurgery, Kobe City Medical Center West Hospital, Kobe, Japan. Electronic address: adachi64@pop21.odn.ne.jp.
⁴ Department of Neurosurgery, Hyogo Emergency Medical Center and Kobe Red Cross Hospital, Kobe, Japan. Electronic address: y-hara@kobe.jrc.or.jp.
⁵ Department of Neurosurgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan. Electronic address: khosoda@med.kobe-u.ac.jp.
⁶ Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: hidekimusbs@gmail.com.
⁷ Department of Neurosurgery, Japan Community Health Care Organization Kobe Central Hospital, Kobe, Japan. Electronic address: kny1616@yahoo.co.jp.
⁸ Department of Neurosurgery, Shinsuma Hospital, Kobe, Japan. Electronic address: mizowakit@yahoo.co.jp.
⁹ Department of Neurosurgery, Konan Medical Center, Kobe, Japan. Electronic address: yasuhiko.motooka@kohnan.or.jp.
¹⁰ Department of Neurosurgery, Kobe Ekisaikai Hospital, Kobe, Japan. Electronic address: kazuya@kobe-ekisaikai.or.jp.
¹¹ Department of Neurosurgery, Kosei Hospital, Kobe, Japan. Electronic address: shinoda8989@yahoo.co.jp.
¹² Department of Neurosurgery, National Hospital Organization Kobe Medical Center, Kobe, Japan. Electronic address: gaasl712@actv.zaq.ne.jp.
¹³ Department of Neurosurgery, Shinko Memorial Hospital, Kobe, Japan. Electronic address: yweno@hotmail.co.jp.
¹⁴ Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan. Electronic address: yama-ns@msc.biglobe.ne.jp.
¹⁵ Department of Neurology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan. Electronic address: chie_yanagihara@kcho.jp.
¹⁶ Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan. Electronic address: yasuhisayoshida1961@gmail.com.
¹⁷ Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan. Electronic address: kawamoto@kcho.jp.
¹⁸ Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan. Electronic address: n.sakai@siren.ocn.ne.jp.

PMID: 33039766
PMCID: PMC7526598
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105343

Abstract

Background: The novel coronavirus disease 2019 (COVID-19) outbreak raised concerns over healthcare systems' ability to provide suitable care to stroke patients. In the present study, we examined the provision of stroke care in Kobe City during the COVID-19 epidemic, where some major stroke centers ceased to provide emergency care.

Methods: This was a cross-sectional study. The Kobe Stroke Network surveyed the number of stroke patients admitted to all primary stroke centers (PSCs) in the city between March 1 and May 23, 2020, and between March 3 and May 25, 2019. In addition, online meetings between all PSC directors were held regularly to share information. The survey items included emergency response system characteristics, number of patients with stroke hospitalized within 7 days of onset, administered treatment types (IV rt-PA, mechanical thrombectomy, surgery, and endovascular therapy), and stroke patients with confirmed COVID-19.

Results: During the period of interest in 2020, the number of stroke patients hospitalized across 13 PSCs was 813, which was 15.5% lower than that during the same period of 2019 (p = 0.285). The number of patients admitted with cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage decreased by 15.4% (p = 0.245), 16.1% (p = 0.659), and 14.0% (p = 0.715), respectively. However, the rates of mechanical thrombectomy and surgery for intracerebral hemorrhage were slightly increased by 12.1% (p = 0.754) and 5.0% (p = 0.538), respectively. PSCs that ceased to provide emergency care reported a decrease in the number of stroke cases of 65.7% compared with the same period in 2019, while other PSCs reported an increase of 0.8%. No case of a patient with stroke and confirmed COVID-19 was reported during the study period.

Conclusion: Kobe City was able to maintain operation of its stroke care systems thanks to close cooperation among all city PSCs and a temporal decrease in the total number of stroke cases.

Keywords: COVID-19; Online meeting; Primary stroke center; Stroke; Stroke systems of care.

MeSH terms

COVID-19*
Cross-Sectional Studies
Delivery of Health Care, Integrated / trends*
Endovascular Procedures / trends*
Hospitalization / trends*
Humans
Japan
Neurosurgical Procedures / trends*
Quality Indicators, Health Care / trends
Stroke / diagnosis
Stroke / therapy*
Thrombectomy / trends*
Thrombolytic Therapy / trends*
Time Factors
Treatment Outcome