Impact of the coronavirus disease 2019 pandemic on stroke teleconsultations in Germany in the first half of 2020

Christoph Vollmuth; Olga Miljukov; Mazen Abu-Mugheisib; Anselm Angermaier; Jessica Barlinn; Loraine Busetto; Armin J Grau; Albrecht Guenther; Christoph Gumbinger; Nikolai Hubert; Katrin Hüttemann; Carsten Klingner; Markus Naumann; Frederick Palm; Jan Remi; Viktoria Rücker; Joachim Schessl; Felix Schlachetzki; Ramona Schuppner; Stefan Schwab; Andreas Schwartz; Adrian Trommer; Christian Urbanek; Bastian Volbers; Joachim Weber; Claudia Wojciechowski; Hans Worthmann; Philipp Zickler; Peter U Heuschmann; Karl Georg Haeusler; Gordian Jan Hubert

doi:10.1111/ene.14787

Impact of the coronavirus disease 2019 pandemic on stroke teleconsultations in Germany in the first half of 2020

Eur J Neurol. 2021 Oct;28(10):3267-3278. doi: 10.1111/ene.14787. Epub 2021 Mar 22.

Authors

Christoph Vollmuth¹, Olga Miljukov², Mazen Abu-Mugheisib³, Anselm Angermaier⁴, Jessica Barlinn⁵, Loraine Busetto⁶, Armin J Grau⁷, Albrecht Guenther⁸, Christoph Gumbinger⁶, Nikolai Hubert⁹, Katrin Hüttemann¹⁰, Carsten Klingner⁸, Markus Naumann¹¹, Frederick Palm¹², Jan Remi¹⁰, Viktoria Rücker², Joachim Schessl¹³, Felix Schlachetzki¹⁴, Ramona Schuppner¹⁵, Stefan Schwab¹⁶, Andreas Schwartz¹⁷, Adrian Trommer¹⁸, Christian Urbanek⁷, Bastian Volbers¹⁶, Joachim Weber^{19

20

21}, Claudia Wojciechowski⁵, Hans Worthmann¹⁵, Philipp Zickler¹¹, Peter U Heuschmann^{2

22}, Karl Georg Haeusler¹, Gordian Jan Hubert⁹

Affiliations

¹ Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
² Institute of Clinical Epidemiology and Biometry, Julius Maximilian University of Würzburg, Würzburg, Germany.
³ Department of Neurology, University Hospital Braunschweig, Braunschweig, Germany.
⁴ Department of Neurology, University Hospital Greifswald, Greifswald, Germany.
⁵ Department of Neurology, University Hospital Dresden, Dresden, Germany.
⁶ Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
⁷ Department of Neurology, Hospital Ludwigshafen, Ludwigshafen, Germany.
⁸ Hans Berger Department of Neurology, University Hospital Jena, Jena, Germany.
⁹ TEMPiS Telemedical Stroke Center, Department of Neurology, Munich Clinic Harlaching, Munich, Germany.
¹⁰ NEVAS Telemedical Stroke Network, Department of Neurology, University Hospital Munich, Munich, Germany.
¹¹ Department of Neurology, University Hospital Augsburg, Augsburg, Germany.
¹² Department of Neurology, Hospital Schleswig, Kiel, Germany.
¹³ Department of Neurology, Hospital Karlsruhe, Karlsruhe, Germany.
¹⁴ TEMPiS Telemedical Stroke Center, Department of Neurology, Center for Vascular Neurology and Intensive Care, Medbo District Hospital Regensburg, University of Regensburg, Regensburg, Germany.
¹⁵ Department of Neurology, Hannover Medical School, Hannover, Germany.
¹⁶ Department of Neurology, University Hospital Erlangen, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
¹⁷ Department of Neurology, Hospital Nordstadt, Hannover, Germany.
¹⁸ Department of Neurology, Hospital Hubertusburg, Wermsdorf, Germany.
¹⁹ Clinic and University Outpatient Clinic for Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
²⁰ Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
²¹ Berlin Institute of Health, Berlin, Germany.
²² Comprehensive Heart Failure Center, Clinical Trial Center Würzburg, University Hospital Würzburg, Julius Maximillian University of Würzburg, Würzburg, Germany.

Abstract

Background and purpose: The effects of the coronavirus disease 2019 (COVID-19) pandemic on telemedical care have not been described on a national level. Thus, we investigated the medical stroke treatment situation before, during, and after the first lockdown in Germany.

Methods: In this nationwide, multicenter study, data from 14 telemedical networks including 31 network centers and 155 spoke hospitals covering large parts of Germany were analyzed regarding patients' characteristics, stroke type/severity, and acute stroke treatment. A survey focusing on potential shortcomings of in-hospital and (telemedical) stroke care during the pandemic was conducted.

Results: Between January 2018 and June 2020, 67,033 telemedical consultations and 38,895 telemedical stroke consultations were conducted. A significant decline of telemedical (p < 0.001) and telemedical stroke consultations (p < 0.001) during the lockdown in March/April 2020 and a reciprocal increase after relaxation of COVID-19 measures in May/June 2020 were observed. Compared to 2018-2019, neither stroke patients' age (p = 0.38), gender (p = 0.44), nor severity of ischemic stroke (p = 0.32) differed in March/April 2020. Whereas the proportion of ischemic stroke patients for whom endovascular treatment (14.3% vs. 14.6%; p = 0.85) was recommended remained stable, there was a nonsignificant trend toward a lower proportion of recommendation of intravenous thrombolysis during the lockdown (19.0% vs. 22.1%; p = 0.052). Despite the majority of participating network centers treating patients with COVID-19, there were no relevant shortcomings reported regarding in-hospital stroke treatment or telemedical stroke care.

Conclusions: Telemedical stroke care in Germany was able to provide full service despite the COVID-19 pandemic, but telemedical consultations declined abruptly during the lockdown period and normalized after relaxation of COVID-19 measures in Germany.

Keywords: COVID-19; SARS-CoV-2; stroke; survey; telemedicine.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Communicable Disease Control
Germany / epidemiology
Humans
Pandemics
Remote Consultation*
SARS-CoV-2
Stroke* / epidemiology
Stroke* / therapy

Grants and funding

413657723/German Research Council