Stroke Care During the First and the Second Waves of the COVID-19 Pandemic in a Community Hospital

Abstract

Objective: The coronavirus disease 2019 (COVID-19) infection may alter a stroke course; thus, we compared stroke course during subsequent pandemic waves in a stroke unit (SU) from a hospital located in a rural area.Methods: A retrospective study included all patients consecutively admitted to the SU between March 15 and May 31, 2020 (“first wave”), and between September 15 and November 30, 2020 (“second wave”). We compared demographic and clinical data, treatments, and outcomes of patients between the first and the second waves of the pandemic and between subjects with and without COVID-19.Results: During the “first wave,” 1.4% of 71 patients were hospitalized due to stroke/TIA, and 41.8% of 91 during the “second wave” were infected with SARS-CoV-2 (p < 0.001). During the “second wave,” more SU staff members were infected with COVID-19 than during the “first wave” (45.6 vs. 8.7%, p < 0.001). Nevertheless, more patients underwent intravenous thrombolysis (26.4 vs. 9.9%, p < 0.008) and endovascular thrombectomy (5.3 vs. 0.0%, p < 0.001) during the second than the first wave. Large vessel occlusion (LVO) (OR 8.74; 95% CI 1.60–47.82; p = 0.012) and higher 30-day mortality (OR 6.01; 95% CI 1.04–34.78; p = 0.045) were associated with patients infected with COVID-19. No differences regarding proportions between ischemic and hemorrhagic strokes and TIAs between both waves or subgroups with and without COVID-19 existed.Conclusion: Despite the greater COVID-19 infection rate among both SU patients and staff during the “second wave” of the pandemic, a higher percentage of reperfusion procedures has been performed then. COVID-19 infection was associated with a higher rate of the LVO and 30-day mortality.

Behavioral and Disease-Related Characteristics of Patients with Acute Stroke during the Coronavirus Disease Pandemic

“…In addition, a multicenter study conducted in Germany showed that the number of stroke admissions decreased during the COVID-19 outbreak, whereas the rate of acute reperfusion therapy was not significantly affected [24]. In contrast, Sobolewski et al [25] reported that the reperfusion procedure increased as the stroke with large vessel occlusion increased during the second wave of the COVID-19 pandemic in Poland. The present study did not show these reductions reported in previous studies.…”

Concurrent Middle Cerebral Artery and Basilar Artery Occlusions Treated With Mechanical Thrombectomy in a Patient With Active COVID-19 Infection

“…As is seen across all types of strokes, COVID-19 infection is associated with poorer prognosis in patients with an LVO [ 19 ]. A study by Ntaios et al found that through their propensity score-matched analysis of COVID-19 patients compared to non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019, the median National Institutes of Health Stroke scale score was found to be higher in patients with COVID-19 compared to patients without COVID-19 (10 (interquartile range (IQR): 4-18) and six (IQR: 3-14), p = 0.03) [ 20 ].…”