An International Report on the Adaptations of Rapid Transient Ischaemic Attack Pathways During the COVID-19 Pandemic

Andy Lim; Shaloo Singhal; Philippa Lavallee; Pierre Amarenco; Peter M Rothwell; Gregory Albers; Mukul Sharma; Robert Brown Jr; Annemarei Ranta; Mohana Maddula; Timothy Kleinig; Jesse Dawson; Mitchell S V Elkind; Maria Guarino; Shelagh B Coutts; Benjamin Clissold; Henry Ma; Thanh Phan

doi:10.1016/j.jstrokecerebrovasdis.2020.105228

An International Report on the Adaptations of Rapid Transient Ischaemic Attack Pathways During the COVID-19 Pandemic

J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105228. doi: 10.1016/j.jstrokecerebrovasdis.2020.105228. Epub 2020 Aug 18.

Authors

Andy Lim¹, Shaloo Singhal², Philippa Lavallee³, Pierre Amarenco³, Peter M Rothwell⁴, Gregory Albers⁵, Mukul Sharma⁶, Robert Brown Jr⁷, Annemarei Ranta⁸, Mohana Maddula⁹, Timothy Kleinig¹⁰, Jesse Dawson¹¹, Mitchell S V Elkind¹², Maria Guarino¹³, Shelagh B Coutts¹⁴, Benjamin Clissold², Henry Ma², Thanh Phan¹⁵

Affiliations

¹ Department of Emergency Medicine, Monash Medical Centre, Melbourne, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
² School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology, Monash Medical Centre, Melbourne, Australia.
³ Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France.
⁴ Nuffield Department of Clinical Neurosciences. Level 6, West Wing, John Radcliffe Hospital, Oxford, United Kingdom.
⁵ Department of Neurology and Stanford Stroke Center, Stanford Medical Center, Palo Alto, CA, USA.
⁶ Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada.
⁷ Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
⁸ Department of Neurology, Wellington Hospital and University of Otago, Wellington.
⁹ Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand.
¹⁰ Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia.
¹¹ Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland.
¹² Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
¹³ IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Interaziendale Clinica Neurologica Metropolitana (NeuroMet), Neurologia AOU S.Orsola, Malpighi, Bologna, Italy.
¹⁴ Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
¹⁵ School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology, Monash Medical Centre, Melbourne, Australia. Electronic address: Thanh.Phan@monash.edu.

PMID: 33066882
PMCID: PMC7434484
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105228

Abstract

Background: This report aims to describe changes that centres providing transient ischaemic attack (TIA) pathway services have made to stay operational in response to the SARS-CoV-2 pandemic.

Methods: An international cross-sectional description of the adaptions of TIA pathways between 30^th March and 6^th May 2020. Experience was reported from 18 centres with rapid TIA pathways in seven countries (Australia, France, UK, Canada, USA, New Zealand, Italy, Canada) from three continents.

Results: All pathways remained active (n = 18). Sixteen (89%) had TIA clinics. Six of these clinics (38%) continued to provide in-person assessment while the majority (63%) used telehealth exclusively. Of these, three reported PPE use and three did not. Five centres with clinics (31%) had adopted a different vascular imaging strategy.

Conclusion: The COVID pandemic has led TIA clinics around the world to adapt and move to the use of telemedicine for outpatient clinic review and modified investigation pathways. Despite the pandemic, all have remained operational.

Keywords: COVID-19; Coronavirus; Delivery of Health Care; Ischemic Attack; Telemedicine; Transient.

Publication types

Multicenter Study

MeSH terms

Australia
COVID-19
Coronavirus Infections / diagnosis
Coronavirus Infections / therapy*
Coronavirus Infections / virology
Critical Pathways / trends*
Cross-Sectional Studies
Delivery of Health Care, Integrated / trends*
Diagnostic Imaging / trends
Europe
Hospital Rapid Response Team / trends*
Humans
Ischemic Attack, Transient / diagnosis
Ischemic Attack, Transient / therapy*
New Zealand
North America
Pandemics
Personal Protective Equipment / trends
Pneumonia, Viral / diagnosis
Pneumonia, Viral / therapy*
Pneumonia, Viral / virology
Practice Patterns, Physicians' / trends*
Telemedicine / trends*
Time Factors