Retrospective Analysis in Efficacy and Safety of Modified Stroke Protocol During the COVID-19 Epidemic: Real-World Experience from a Single Healthcare System

Introduction The COVID-19 pandemic has posed significant challenges to healthcare systems and public health. We wonder whether modified stroke protocol (MSP) could provide timely treatment with comparable efficacy in acute stroke care. Methods Participants were victims of acute ischemic stroke who underwent endovascular therapy between January 2021 and July 2021. Modified stroke protocol (MSP) claims to conduct nasopharyngeal swab nucleic acid amplification test (NAAT) immediately while encountering a stroke patient suspected of having COVID-19. The efficacy outcome included good functional outcome (mRS score, 0 to 2 at 90 days). Safety outcomes were symptomatic intracranial hemorrhage within 36 hours and overall mortality at 3 months. Results Of the 61 patients with acute ischemic stroke who received endovascular therapy enrolled in our analysis, 17 patients were in the MSP group. Overall, there were comparable rates of good functional outcome between the MSP group (23.5%) and the usual care group (23.8%) (OR, 1.54; 95% CI, 0.25 to 9.39). Mortality at 90 days was equivalent: 29.4% in the MSP group and 26.2% in the usual care group (OR, 0.64; 95% CI, 0.10 to 4.17). The risk of symptomatic intracranial hemorrhage within 36 hours was 17.6% in the MSP group and 6.8% in the usual care group (OR, 0.16; 95% CI, 0.01 to 4.37). Conclusions Acute ischemic stroke patients in the MSP group had similar functional outcome with those in the usual care group, without significant increase in the rate of mortality at 3 months and symptomatic intracranial hemorrhage within 36 hours.