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?:abstract
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The aim of the article was to propose a modified emergency department (ED) stroke code for the evaluation of patients with confirmed or suspected COVID-19 A stroke code used in COVID-19 patients with a time-sensitive condition such as AIS needs to ensure not only a rapid patient management, but also stroke team safety and the optimal and safe use of scan rooms and angio-suites In the pre-pandemic times, many EDs have adopted an Acute Stroke Code, an algorithm facilitating rapid assessment of patients presenting with signs and symptoms of AIS The stroke code triggers the activation of the stroke team, which comprises of an ED specialist, neurologist, radiographers, and radiologist During the COVID-19 pandemic, a need arose for a modified stroke code that would include COVID-19 screening To minimize the risk for health care workers during patient assessment and management, all personnel should wear adequate personal protective equipment (PPE) and maintain a distance of at least two from the patient, unless strictly necessary Since stroke evaluation does not generate aerosols, the use of a positive air purified respirator may depend on its availability and institutional policy The stroke team should comprise of a minimum number of health care providers and use telemedicine to review the evaluation process Emergency physicians must have a high level of suspicion to identify AIS as an initial presentation of COVID-19 To address the challenges during this pandemic, a modified stroke code with a dedicated workflow needs to be established for screening, evaluation, and safe, coordinated management of AIS patients in the ED The implementation of a strict screening process in the ED can help identify suspect or confirmed COVID-19 patients The adherence to infection control measures by all members of the stroke team, a dedicated facility for neuro-imaging, and subsequent intervention in the angio-suite can ensure timely, safe, and optimal stroke management This article proposes a modified stroke code addressing all these issues that can be individualized and adopted based on local institutional practice
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