The Baffling Case of Ischemic Stroke Disappearance from the Casualty Department in the COVID-19 Era

Morelli, Nicola; Rota, Eugenia; Terracciano, Chiara; Immovilli, Paolo; Spallazzi, Marco; Colombi, Davide; Zaino, Domenica; Michieletti, Emanuele; Guidetti, Donata

doi:10.1159/000507666

Cited by 181 publications

(219 citation statements)

References 10 publications

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“…The authors do not provide further details for these findings and the number of stroke unit admissions and study periods are not specified. In the editorial of Morelli et al [6] the authors note a marked reduction in emergency admissions with symptoms of acute strokeonly six admissions between 21 February and 25 March 2020, compared to a monthly average of 51 cases in previous years. Several factors could potentially explain this phenomenon.…”

Section: Discussionmentioning

confidence: 96%

“…Since the onset of the pandemic, several groups reported marked and unexplained decreases in the Correspondence volume of patients with acute cardiovascular pathologies apparently unrelated to COVID-19 infection, such as myocardial infarction [3,4] and acute ischaemic stroke [5,6]. However, up to now, no study has attempted to quantify the impact of the COVID-19 outbreak on incidence and treatment rates of acute stroke.…”

Section: Introductionmentioning

confidence: 99%

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Impact of the COVID‐19 outbreak on acute stroke pathways – insights from the Alsace region in France

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Quenardelle

Hasiu

et al. 2020

Euro J of Neurology

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Background and purposeTo date, no study has attempted to quantify the impact of the COVID‐19 outbreak on the incidence and treatment of acute stroke.MethodsThis was a retrospective review of acute stroke pathway parameters in all three stroke units in the Alsace region during the first month of the outbreak (1–31 March 2020), using the similar period from 2019 as a comparator. A secondary detailed analysis of all stroke alerts and stroke unit admissions was performed in the centre with the largest case volume.ResultsCompared to the same period in 2019, in March 2020 there were 39.6% fewer stroke alerts and 33.3% fewer acute revascularization treatments [40.9% less intravenous thrombolysis (IVT) and 27.6% less mechanical thrombectomy (MT)]. No marked variation was observed in the number of stroke unit admissions (−0.6%). The proportion of patients with acute revascularization treatments (IVT or MT) out of the total number of stroke unit admissions was significantly lower in March 2020 (21.3%) compared to 2019 (31.8%), P = 0.034. There were no significant differences in time delays or severity of clinical symptoms for patients treated by IVT or MT, nor in the distribution of final diagnosis amongst stroke alerts and stroke unit admissions.ConclusionThese results suggest that the overall incidence of stroke remained the same, but fewer patients presented within the therapeutic time window. Increased public awareness and corrective measures are needed to mitigate the deleterious effects of the COVID‐19 outbreak on acute stroke care.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Impact of the COVID‐19 outbreak on acute stroke pathways – insights from the Alsace region in France

Pop

Quenardelle

Hasiu

et al. 2020

Euro J of Neurology

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“…For the time being this does not seem to be the case. For example, stroke incidence is significantly decreased in the COVID-19 era (22,23). Furthermore, in the case of migraine, recent experience from Italy showed that despite the fact that hospitals nowadays are considered non-secure places, patients suffering from severe migraine (who were under monthly treatment with IV medication) seemed to manage to overcome their fear of COVID-19, as they neglected the posed traffic restrictions by the government and made it to the hospital, in order to have their anti-migraine IV treatment administered (24).…”

Section: Neurologymentioning

confidence: 99%

COVID‑19 related stress exacerbates common physical and mental pathologies and affects treatment (Review)

et al. 2020

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COVID-19 pandemic has caused a global public health emergency resulting in unprecedented individual and societal fear and anxiety. The stress surrounding this biothreat appears to have clinical implications in all aspects of medicine, both in mental and physical health spheres. The impact of COVID-19 related anxiety in Cardiology, Paediatrics, Oncology, Dermatology, Neurology and Mental Health and how it affects treatments is discussed. Moreover, the need for introducing novel communication and therapeutic approaches is highlighted in the new landscape of the COVID-19 era.

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“…For stroke, single center reports and sharing of national experiences also suggests a marked decrease in stroke admissions. 3,4 In Italy, the outbreak of COVID-19 was associated with a 32% decline in the number of percutaneous coronary interventions (PCI) for ACS. 5 A study of 7 centers in the United States reported a 38% decrease in cardiac catheterization laboratory activations in March 2020.…”

Section: Introductionmentioning

confidence: 99%

Decreased Stroke, Acute Coronary Syndrome, and Corresponding Interventions at 65 US Hospitals Following COVID-19

Havenon

Callaghan

et al. 2020

Preprint

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The Baffling Case of Ischemic Stroke Disappearance from the Casualty Department in the COVID-19 Era

Cited by 181 publications

References 10 publications

Impact of the COVID‐19 outbreak on acute stroke pathways – insights from the Alsace region in France

Impact of the COVID‐19 outbreak on acute stroke pathways – insights from the Alsace region in France

COVID‑19 related stress exacerbates common physical and mental pathologies and affects treatment (Review)

Decreased Stroke, Acute Coronary Syndrome, and Corresponding Interventions at 65 US Hospitals Following COVID-19

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