Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India

Abstract

Background As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected. Aims The present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019. Methods The COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points. Results A total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods. Conclusions Although stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.

Impact of the COVID-19 Pandemic in the Acute Stroke Admissions and Outcomes in a Philippine Tertiary Hospital

“…The proportion of hemorrhagic stroke was significantly higher during the pandemic at 26% of stroke admissions compared to 19% pre-pandemic which may also be a reflection of those with worse stroke manifestation of being seen and admitted at hospitals during the pandemic. These findings are different from those reported by Bhatia et al [ 20 ], where the increase in number of hemorrhagic strokes was not significant during pandemic. Taking these factors into consideration, the outcomes of stroke admissions have been greatly impacted by the COVID-19 pandemic with significantly lower proportion of stroke cases discharged with good functional outcome and higher proportion of dependent patients upon discharge during pandemic which was also observed in other countries [ 7 , 16 , 17 , 21 ].…”

“…Taking these factors into consideration, the outcomes of stroke admissions have been greatly impacted by the COVID-19 pandemic with significantly lower proportion of stroke cases discharged with good functional outcome and higher proportion of dependent patients upon discharge during pandemic which was also observed in other countries [ 7 , 16 , 17 , 21 ]. The proportion of stroke admissions resulting in mortality almost doubled from 7% before COVID-19 to 13% during COVID-19, and these were also seen in previous studies [ 20 , 21 ]. There are many possible contributory factors resulting to more stroke cases having poor discharge outcome, and most of these factors are possibly secondary to: limited mobility in the Philippines while on the longest lockdown in the world, reluctance to seek consultation, and increasing COVID-19 cases that overwhelm the emergency room of the hospital.…”

“…What was evident in the study was the significant reduction in the proportion of patients receiving acute stroke unit admission, therefore missing out on more appropriate acute stroke care during pandemic that reaches up to approximately half compared to pre-pandemic proportions. This reduction may be possibly due to the conversion of the acute stroke unit into COVID-isolation intensive care unit and may have disrupted the chain of stroke care during pandemic which had greatly affected stroke outcomes including higher mortality seen in other studies [ 7 , 16 , 17 , 20 , 21 ].…”

Effect of Decompression Craniectomy on Survival and Functional Outcome in Patients with COVID-19 and Malignant Infarct: A Retrospective Cohort Study and Review of Literature

“…Although there has been no decrease in stroke admissions during the pandemic period as compared to pre-pandemic period, there has been a decline in the mechanical thrombectomy procedures globally, increased in-hospital complications and mortality. 8 COVID-19 has also challenged the surgical services and training, largely due to deployment of doctors in other areas, adherence to the COVID-19 protocols and reduction in training opportunities due to decrease in number of elective surgeries. 9 Decompression craniectomy in stroke is a life-saving procedure in patients with malignant cerebral infarction.…”

Comparison of Disease Profiles and Three-Month Outcomes of Patients with Neurological Disorders with and without COVID-19

“…[ 2 4 ] However, structured data on follow-up outcomes in the form of survival and disability among these patients is scarce, and would be needed for prognostication. While there is emerging data on disease-specific outcomes in COVID-19 positive and negative patients,[ 5 6 ] the overall statistics amongst neurological illnesses is lacking. In addition, the long-term outcome comparison data are also scarce.…”