Delayed presentation of acute ischemic strokes during the COVID-19 crisis

Schirmer, Clemens M.; Ringer, Andrew J.; Arthur, Adam S; Binning, Mandy J.; Fox, W. Christopher; James, Robert F.; Levitt, Michael R.; Tawk, Rabih G.; Veznedaroglu, Erol; Walker, Melanie; Spiotta, Alejandro M

doi:10.1136/neurintsurg-2020-016299

Cited by 139 publications

(140 citation statements)

References 16 publications

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“…There was also no significant difference in NIHSS score between March 2019 and March 2020 (p=0.8173). This was consistent with Schirmer et al who reported no change in NIH score from 2019 [ 9 ]. Finally, the patient outcomes as measured by mRS were similar between March and April 2019 and March and April of 2020 (p=0.49) (Table 1 ).…”

Section: Discussionsupporting

confidence: 92%

“…A delay in management of stroke patients may be related to the COVID-19 pandemic. Schirmer et al compared stroke severity and time to presentation between patients who presented with stroke in the pre-COVID and intra-COVID period at twelve institutions, and the corresponding months from one year prior [ 9 ]. There was a significant increase in time interval between symptom onset and time to presentation to a stroke center.…”

Section: Discussionmentioning

confidence: 99%

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Effects of the COVID-19 Pandemic on Stroke Patients

Ghanchi¹,

Takayanagi²,

Savla³

et al. 2020

Cureus

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Introduction The severe acute respiratory syndrome coronavirus 2 (SARS2-CoV-2) induced pandemic (COVID-19 pandemic) has affected healthcare in all aspects, including stroke care. We sought to investigate this effect with analysis of our hospital’s stroke treatment protocols as well as stroke volume on state, regional, and national levels. Methods This was a retrospective review of prospectively collected data from our stroke registry to assess the impact of the SARS2-CoV-2 induced pandemic on the volume of stroke patients presenting to our facility. Demographics collected included age, sex, race, National Institute of Health Stroke Scale (NIHSS) on admission, discharge modified Rankin Score (mRS), type of stroke (ischemic, hemorrhagic, or transient ischemic attack), time of symptom onset, and time to initial imaging. Data were also stratified by date and comparison was made between the intra-COVID-period (March and April 2020), pre-COVID period (March and April 2019), and peri-COVID period (January and February 2020). To determine stroke trends on a national level, we utilized the Get with the Guidelines (GWTG) stroke database to compare stroke volumes in the pre-COVID, peri-COVID, and intra-COVID periods between our hospital, all California hospitals, and the West and Pacific regions. Results There was a significant increase in last known well time (LKWT) to arrival to the emergency department (ED) (LKWT to door) as well as time from arrival to the ED to obtaining a computed tomography (CT) of the head (door to CT) in March 2020 compared to 2019 (p=0.0220 and p=0.0475, respectively). There were significantly fewer transient ischemic attacks (TIAs) in California hospitals as well as in March and April 2020 in comparison to January and February 2020 (p=0.0417). Similarly, there were significantly fewer TIAs in March and April 2019 compared to March and April 2020 (p=0.0360). The decrease in TIAs was also seen at our hospital in both time frame comparisons as well as in West Regional Hospitals in March and April 2020 compared to March and April 2019 (p=0.0111, p=0.0215, and p=0.0414, respectively). Conclusion Stroke care has been disrupted by the COVID-19 pandemic worldwide. We identified a delay in LKWT to door as well as time from door to CT in March 2020 compared to March 2019 at our institution. There was a statistically significant decrease in final diagnosis of TIA at our hospital, all California hospitals, and all West Regional hospitals during the March-April 2020 window, suggesting that some patients with minor stroke symptoms may not be presenting to the hospital in the midst of the pandemic. Strategies to minimize delays in care and maximize functional recovery must continue to evolve as new challenges are met during the COVID-19 pandemic.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Effects of the COVID-19 Pandemic on Stroke Patients

Ghanchi¹,

Takayanagi²,

Savla³

et al. 2020

Cureus

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“…Moreover, for a number of reasons including fear of contagion or severe illness complications due to COVID-19 infection, a number of patients with acute cerebrovascular diseases remained home, losing the possibility of being correctly treated. This phenomenon was similarly observed in a number of countries [35,38,[56][57][58]. Last, the outpatient assistance of stroke survivors was also highly reduced or stopped.…”

Section: Discussionmentioning

confidence: 61%

Stroke care in Italy at the time of the COVID-19 pandemic: a lesson to learn

Bersano

Pantoni

2020

J Neurol

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From March to May 2020, the Italian health care system, as many others, was almost entirely devoted to the fight against the COVID-19 pandemic. In this context, a number of questions arose, from the increased stroke risk due to COVID-19 infection to the quality of stroke patient care. The overwhelming need of COVID-19 patient management made mandatory a complete reorganization of the stroke pathways: many health professionals were reallocated and a number of stroke units was turned into COVID-19 wards. As a result, acute stroke care suffered from a shortage of services and delays in time-dependent treatments and diagnostic work-up. In-patient and outpatient care and rehabilitation facilities for stroke survivors were also reduced or slowed down, to direct resources to COVID-19 patients care and to reduce contagion risks. Overall, this is likely to result in a significant future increased burden of complications and disabilities that will impact the health care systems in the coming months. Thus, while still fighting against COVID-19 disease, authorities need to promptly implement robust action plans, including an increase of workforce, without forgetting the assurance of a high level of stroke care. The medical community and the health care administrators should always keep in mind that stroke was before, and will be after the pandemic, a, sometimes, life-threatening condition, and almost always a disease with a severe impact on the quality of life.

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“…and the Endovascular Neurosurgery Research Group published data demonstrating that patients had a significantly longer last known well to time of presentation interval during the COVID-era. 10 This finding has been corroborated by several institutions and groups across the world. 8 A recent study from a single center in New Jersey, one of the most heavily COVID-impacted states in the country, corroborated the decrease in overall stroke volume but also found a greater proportion of patients with stroke presenting with LVOs during the COVID-19 period.…”

Section: Where Have All the Strokes Gone?mentioning

confidence: 71%