Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic

Ortega‐Gutiérrez, Santiago; Farooqui, Mudassir; Zha, Alicia; Czap, Alexandra L; Sebaugh, Jacob; Desai, Shashvat; Jadhav, Ashutosh P.; Vora, Nirav; Rai, Vivek; Jovin, Tudor G; Thon, Jesse M.; Heslin, Mark; Thau, Lauren; Zevallos, Cynthia; Quispe‐Orozco, Darko; Jillella, Dinesh; Nahab, Fadi; Mohammaden, Mahmoud; Nogueira, Raul G; Haussen, Diogo C; Nguyen, Thanh N.; Romero, José R.; Aparicio, Hugo J.; Osman, Mahmoud M.; Haq, Israr Ul; Liebeskind, David S; Hassan, Ameer E.; Zaidat, Osama O.; Siegler, James E.

doi:10.1016/j.clineuro.2020.106436

Cited by 38 publications

(35 citation statements)

References 34 publications

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“…1 Changes in prehospital emergency medical service, emergency room care, acute stroke and subarachnoid haemorrhage (SAH) protocols 2 3 were reported to conserve resources and to mitigate infection risk to patients and their providers. Decreases in ischaemic stroke admission, rates of intravenous thrombolysis (IVT) [4][5][6] and mechanical thrombectomy (MT) volume 7 were reported in several regions in Europe, 8 9 Germany, 10 China, 11 Brazil 12 and the USA, 13 14 with steeper declines in stroke hospitalisations seen in areas with higher COVID-19 hospitalisation volume. 15 However, there is a paucity of information on the impact of the COVID-19 pandemic on SAH admissions.…”

Section: Introductionmentioning

confidence: 99%

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

et al. 2021

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BackgroundDuring the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.MethodsWe conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.FindingsThere was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170–1035 procedures, respectively, representing an 11.5% (95%CI −13.5% to −9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI −28.0% to −22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile.InterpretationThere was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.

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Section: Introductionmentioning

confidence: 99%

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

et al. 2021

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“…15 In addition, a multicenter observational study across 8 states in the US reported significant decline in weekly stroke admissions, but the proportion of patients receiving IVT and MT remained the same during the months of March, April and May 2020 compared to the same period in 2019. 16 In the subgroup of countries of Germany, France, Italy and Poland, there was a median percentage increase of 85% and 113% in stroke admission in medium and high-volume centers respectively and 22% increase in MT performed in high-volume centers due to a pandemicrelated change in their pre-hospital stroke triage policy to direct all strokes to designated centers only during the pandemic. As such, this reported increase in stroke admissions and MT performed in countries with STP change is unlikely to represent a true measure of the overall change in the stroke admission and MT during COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

International Survey of Mechanical Thrombectomy Stroke Systems of Care During COVID-19 Pandemic

Yavagal

Saini

Inoa

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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Background The COVID-19 pandemic has strained the healthcare systems across the world but its impact on acute stroke care is just being elucidated. We hypothesized a major global impact of COVID-19 not only on stroke volumes but also on various aspects of thrombectomy systems. Aims We conducted a convenience electronic survey with a 21-item questionnaire aimed to identify the changes in stroke admission volumes and thrombectomy treatment practices seen during a specified time period of the COVID-19 pandemic. Methods The survey was designed using Qualtrics software and sent to stroke and neuro-interventional physicians around the world who are part of the Global Executive Committee (GEC) of Mission Thrombectomy 2020, a global coalition under the aegis of Society of Vascular and Interventional Neurology, between April 5th to May 15th, 2020. Results There were 113 responses to the survey across 25 countries with a response rate of 31% among the GEC members. Globally there was a median 33% decrease in stroke admissions and a 25% decrease in mechanical thrombectomy (MT) procedures during the COVID-19 pandemic period until May 15 th , 2020 compared to pre-pandemic months. The intubation policy for MT procedures during the pandemic was highly variable across participating centers: 44% preferred intubating all patients, including 25% of centers that changed their policy to preferred-intubation (PI) from preferred non-intubation (PNI). On the other hand, 56% centers preferred not intubating patients undergoing MT, which included 27% centers that changed their policy from PI to PNI. There was no significant difference in rate of COVID-19 infection between PI versus PNI centers (p=0.60) or if intubation policy was changed in either direction (p=1.00). Low-volume (<10 stroke/month) compared with high-volume stroke centers (>20 strokes/month) were less likely to have neurointerventional suite specific written personal protective equipment protocols (74% vs 88%) and if present, these centers were more likely to report them to be inadequate (58% vs 92%). Conclusion Our data provides a comprehensive snapshot of the impact on acute stroke care observed worldwide during the pandemic. Overall, respondents reported decreased stroke admissions as well as decreased cases of MT with no clear preponderance in intubation policy during MT. Data access statement The corresponding author will consider requests for sharing survey data. The study was exempt from institutional review board approval as it did not involve patient level data.

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“…A drop in number of stroke patients admitted to hospitals has been reported frequently and was linked to an avoidance to seek hospital treatment during an increasing intensity of lockdown measures [11,12]. While conclusions are frequently drawn comparing stroke care during the pandemic with that one provided in a pre-pandemic setting [4][5][6]11,12], our data for comparing the first with the second wave of the pandemic supports the hypothesis that the number of stroke admissions largely depends on regional variability of SARS-CoV-2 incidence rather than strict containment measures alone. The site studied in this analysis was barely hit by the first wave of the pandemic, yet it belonged to the most severely affected regions in Germany during the second wave of the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Overall length of hospitalization was prolonged during the second wave of the pandemic when compared to the first wave (7 (4, 13) vs. 5 (5,17) days, p < 0.001). When we analyzed length of hospitalization by discharge modality, results remained significant solely for patients transferred to an inpatient rehabilitation facility (20 (12, 27) vs. 12 (8, 18) days, p < 0.0001).…”

Section: Evidence-based Stroke Carementioning

confidence: 95%

Delayed Comprehensive Stroke Unit Care Attributable to the Evolution of Infection Protection Measures across Two Consecutive Waves of the COVID-19 Pandemic

Sedghi

Siepmann

Pallesen

et al. 2021

Life

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We aimed to assess how evidence-based stroke care changed over the two waves of the COVID-19 pandemic. We analyzed acute stroke patients admitted to a tertiary care hospital in Germany during the first (2 March 2020–9 June 2020) and second (23 September 2020–31 December 2020, 100 days each) infection waves. Stroke care performance indicators were compared among waves. A 25.2% decline of acute stroke admissions was noted during the second (n = 249) compared with the first (n = 333) wave of the pandemic. Patients were more frequently tested SARS-CoV-2 positive during the second than the first wave (11 (4.4%) vs. 0; p < 0.001). There were no differences in rates of reperfusion therapies (37% vs. 36.5%; p = 1.0) or treatment process times (p > 0.05). However, stroke unit access was more frequently delayed (17 (6.8%) vs. 5 (1.5%); p = 0.001), and hospitalization until inpatient rehabilitation was longer (20 (1, 27) vs. 12 (8, 17) days; p < 0.0001) during the second compared with the first pandemic wave. Clinical severity, stroke etiology, appropriate secondary prevention medication, and discharge disposition were comparable among both waves. Infection control measures may adversely affect access to stroke unit care and extend hospitalization, while performance indicators of hyperacute stroke care seem to be untainted.

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Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic

Cited by 38 publications

References 34 publications

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

International Survey of Mechanical Thrombectomy Stroke Systems of Care During COVID-19 Pandemic

Delayed Comprehensive Stroke Unit Care Attributable to the Evolution of Infection Protection Measures across Two Consecutive Waves of the COVID-19 Pandemic

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