Decline in Stroke Presentations During COVID-19 Surge

Uchino, Ken; Kolikonda, Murali K; Brown, Dena R; Kovi, Shivakrishna; Collins, Dana R.; Khawaja, Zeshaun; Buletko, Andrew Blake; Russman, Andrew; Hussain, Muzna

doi:10.1161/strokeaha.120.030331

Cited by 125 publications

(155 citation statements)

References 5 publications

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“…COVID-19 is associated with a hypercoagulable state that may lead to an increase in acute cerebrovascular events with an increase in ischaemic strokes and large vessel occlusion strokes [2][3][4]. Preliminary global reports show a reduction in the number of stroke admissions with a delay in the presentation of acute ischaemic strokes and time to thrombolysis and thrombectomy [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

et al. 2020

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Introduction The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. Methods This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). Results There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. Conclusions During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.

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Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

et al. 2020

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“…The admission of AIS patients were not decreased during the pandemic, which was quite different from the United States [7]. This may be because: (a) as a regional comprehensive stroke center, the stroke unit remained open during the pandemic; (b) even during the pandemic, patients still tended to visit a comprehensive stroke center rather than a nearest primary stroke center; (c) stroke causes more concern and afraid even than COVID-19 due to the serious sequelae and consequence; (d) the popularity of stroke education to the public in recent years.…”

Section: Challenges and Changes In Stroke Care Systemsmentioning

confidence: 76%

“…On the other hand, some media and doctors have noticed a drop in admissions for acute myocardial infarction patients [5,6] and stroke patients [7], while their morbidities are rarely possible to decline during the pandemic.…”

Section: Introductionmentioning

confidence: 99%

“…To make matters worse, as the pandemic continues, these effects may last for several years or even longer. However, the exact effects on stroke care systems caused by COVID-19 stay unclear, and the conclusions of previous studies remain controversial [7,8]. In addition, because of the obvious differences in national conditions, medical standards, medical systems, political systems, customs and cultures among countries, it is necessary to conduct fully studies on different economies such as China, the United States, the Europe Union, etc.…”

Section: Introductionmentioning

confidence: 99%

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Coronavirus Disease 2019 is Threatening Stroke Care Systems: Challenge and Management

Xin¹,

Huang²,

Liu³

et al. 2020

Preprint

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Background Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the stroke care systems have been seriously affected because of social restrictions and other reasons. As the pandemic spreads further to global, it is of great significant to understand how COVID-19 affect the stroke care systems. Methods We retrospectively studied the real-world data of one comprehensive stroke center in China from January to February, 2020, and compared it with the same period in 2019. We analyzed time from stroke onset to admission, severity, effect after treatment, hospital stays, cost of hospitalization, etc., and correlation among them. Results We observed a great extension of the onset-to-door time of stroke patients during the pandemic. The degree of neurological deficit of the patients was significantly higher, both admission and discharge. Longer onset-to-door time and higher degree of neurological deficit were significantly correlated with longer hospital stays and higher medical burden. Conclusions COVID-19 pandemic is threatening the stroke care systems. Measures must be taken to minimize the collateral damage caused by COVID-19.

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“…Although an association between COVID-19 and stroke has gained recent attention, current evidence does not establish causality. Although there have been published reports on decline in stroke presentations during the COVID-19 pandemic, there could be a surge of acute cerebrovascular pathologies with growing emergence of association between COVID-19 and stroke [25]. Maintaining the availability of timely evaluation and/or intervention for patients with acute cerebrovascular diseases is imperative.…”

Section: Resultsmentioning

confidence: 99%

Association of Coronavirus Disease 2019 and Stroke: A Rising Concern

2020

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The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) causes the coronavirus disease 2019 (COVID-19). It quickly became pandemic, and so did a new concern about COVID-19 infections increasing the risk for cerebrovascular diseases. There is an association between COVID-19 illness in people and acute stroke. Several chemical, mechanical, and/or inflammatory central nervous system pathologies are proposed to explain how this viral infection might induce acute cerebrovascular disease. Timely available evaluation and/or intervention is imperative for patients with concerns about acute cerebrovascular issues.

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Decline in Stroke Presentations During COVID-19 Surge

Cited by 125 publications

References 5 publications

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

Coronavirus Disease 2019 is Threatening Stroke Care Systems: Challenge and Management

Association of Coronavirus Disease 2019 and Stroke: A Rising Concern

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