The Impact of COVID-19 on Emergent Large-Vessel Occlusion: Delayed Presentation Confirmed by ASPECTS

Altschul, David; Haranhalli, Neil; Esenwa, Charles; Unda, Santiago R.; Ramos, Rafael De la Garza; Dardick, Joseph; Fernandez-Torres, Jenelys; Toma, Aureliana; Labovitz, Daniel L.; Cheng, Natalie; Lee, S.K.; Brook, Allan; Zampolin, Richard L.

doi:10.3174/ajnr.a6800

Cited by 10 publications

(23 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prior studies demonstrate inconsistent findings regarding delayed presentation times, though for the most part show door to CT, needle, and endovascular times remain similar during the pandemic when compared with the pre-COVID-19 era. 7 , 15 , 26 – 30 Although we expected delays for thrombolysis and thrombectomy in our during COVID-19 cohort due to the need for additional personal protective equipment, the relatively preserved door to diagnosis and door to intervention times suggest the donning of personal protective equipment did not lead to delayed patient care.…”

Section: Discussionmentioning

confidence: 91%

See 1 more Smart Citation

Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19

Srivastava

Zhang

Xian

et al. 2021

Stroke

View full text Add to dashboard Cite

Background and Purpose: The coronavirus disease 2019 (COVID-19) pandemic has created challenges in the delivery of acute stroke care. In this study, we analyze the characteristics, evaluation, treatment, and in-hospital outcomes of patients presenting with acute ischemic stroke (AIS) pre-COVID-19 and during COVID-19. Methods: Get With The Guidelines-Stroke is a national registry of adults with stroke in the United States. Using this registry, we identified patients with a diagnosis of AIS before (n=39 113; November 1, 2019–February 3, 2020) and after (n=41 971; February 4, 2020–June 29, 2020) the first reported case of COVID-19 in the registry. Characteristics, treatment patterns, quality metrics, and in-hospital outcomes were compared between the 2 groups. Results: Stroke presentations decreased by an average of 15.3% per week in the during COVID-19 time period when compared with similar months in 2019. Compared with patients with AIS in the pre-COVID-19 era, patients in the COVID-19 time period had similar rates of intravenous alteplase and endovascular therapy, and similar door to computed tomography, door to needle, and door to endovascular therapy times. In adjusted models, inpatient mortality was similar between those presenting with AIS pre-COVID-19 and during COVID-19 (4.8% versus 5.2%; odds ratio, 1.05 [95% CI, 0.97–1.13]). Conclusions: Among hospitals participating in Get With The Guidelines-Stroke, patients presenting with AIS during COVID-19 received, with few exceptions, similar quality care and experienced similar risk-adjusted outcomes when compared with patients with AIS presenting pre-COVID-19. These findings demonstrate that stroke care in the United States remains robust during the COVID-19 pandemic.

show abstract

Section: Discussionmentioning

confidence: 91%

“…These results are consistent with prior published studies that demonstrate no increase in in-hospital mortality among stroke patients during COVID-19, further supporting the notion that stroke care has been relatively well preserved during the pandemic. 15 , 18 , 27 , 31 …”

Section: Discussionmentioning

confidence: 99%

Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19

Srivastava

Zhang

Xian

et al. 2021

Stroke

View full text Add to dashboard Cite

show abstract

“…The majority of the included studies satisfied the selection and exposure ascertainment criteria. However, cohorts of certain studies were judged not to be truly representative of community patients suffering from stroke, as they included only specific patient subpopulations restricted to patients receiving MT, 17 , 31 , 58 IVT, 60 or any reperfusion therapies. 42 In another study, data regarding stroke incidence and treatment delivery were derived from telemedicine records.…”

Section: Resultsmentioning

confidence: 99%

Changes in Stroke Hospital Care During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Katsanos

Palaiodimou

Zand

et al. 2021

Stroke

View full text Add to dashboard Cite

Background and Purpose: We systematically evaluated the impact of the coronavirus 2019 (COVID-19) pandemic on stroke care across the world. Methods: Observational studies comparing characteristics, acute treatment delivery, or hospitalization outcomes between patients with stroke admitted during the COVID-19 pandemic and those admitted before the pandemic were identified by Medline, Scopus, and Embase databases search. Random-effects meta-analyses were conducted for all outcomes. Results: We identified 46 studies including 129 491 patients. Patients admitted with stroke during the COVID-19 pandemic were found to be younger (mean difference, −1.19 [95% CI, −2.05 to −0.32]; I 2 =70%) and more frequently male (odds ratio, 1.11 [95% CI, 1.01–1.22]; I 2 =54%) compared with patients admitted with stroke in the prepandemic era. Patients admitted with stroke during the COVID-19 pandemic, also, had higher baseline National Institutes of Health Stroke Scale scores (mean difference, 0.55 [95% CI, 0.12–0.98]; I 2 =90%), higher probability for large vessel occlusion presence (odds ratio, 1.63 [95% CI, 1.07–2.48]; I 2 =49%) and higher risk for in-hospital mortality (odds ratio, 1.26 [95% CI, 1.05–1.52]; I 2 =55%). Patients with acute ischemic stroke admitted during the COVID-19 pandemic had higher probability of receiving endovascular thrombectomy treatment (odds ratio, 1.24 [95% CI, 1.05–1.47]; I 2 =40%). No difference in the rates of intravenous thrombolysis administration or difference in time metrics regarding onset to treatment time for intravenous thrombolysis and onset to groin puncture time for endovascular thrombectomy were detected. Conclusions: The present systematic review and meta-analysis indicates an increased prevalence of younger patients, more severe strokes attributed to large vessel occlusion, and higher endovascular treatment rates during the COVID-19 pandemic. Patients admitted with stroke during the COVID-19 pandemic had higher in-hospital mortality. These findings need to be interpreted with caution in view of discrepant reports and heterogeneity being present across studies.

show abstract

“…For example, in some countries, there have been significant reductions in stroke/transient ischemic attack (TIA) admissions and emergency department stroke alerts during COVID-19 compared to the same period the previous year, because they were unable to access medical care. This most likely has led to increased morbidity and mortality in patients with stroke [ 9 ]. Also, SARS-CoV-2 infection has been associated with specific neurological manifestations and increased the incidence of central and peripheral nervous system syndromes [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations

et al. 2021

View full text Add to dashboard Cite

Background The COVID-19 pandemic outbreak has dramatically disrupted healthcare systems. Two rapid WHO pulse surveys studied disruptions in mental health services, but did not particularly focus on neurology. Here, a global survey was conducted and addresses the impact of the pandemic on neurology services. Methods A cross-sectional study was carried out in which 34 international neurological associations were asked to distribute the survey to national associations. The responses represented the national situation, in November–December 2020, with regard to the main disrupted neurological services, reasons and the mitigation strategies implemented as well as the disruption on training of residents and on neurological research. A comparison with the situation in February–April 2020, first pandemic wave, was also requested. Findings 54 completed surveys came from 43 countries covering all the 6 WHO regions. Overall, neurological services disruption was reported as mild by 26%, moderate by 30%, complete by 13% of associations. The most affected services were cross-sectoral neurological services (57%) and neurorehabilitation (56%). The second wave of the pandemic, however, was associated with the improvement of service provision for diagnostics services (44%) and for neurorehabilitation (41%). Governmental directives were the major cause of services’ disruption (56%). Mitigation strategies were mostly established through telemedicine (48%). Almost half of respondents reported a significant impact on neurological research (48%) and educational activities (60%). Most associations (67%) were not involved in decision making for neurological patients’ issues by their national government. Interpretation The COVID-19 pandemic affects neurological services and raises the universal need for the development of neurological health care at the policy, systems and services levels. A global national plan on mitigation strategies for disruption of neurological services during pandemic situations should be established and neurological scientific and patients associations should get involved in decision making. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10641-3.

show abstract

The Impact of COVID-19 on Emergent Large-Vessel Occlusion: Delayed Presentation Confirmed by ASPECTS

Cited by 10 publications

References 9 publications

Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19

Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19

Changes in Stroke Hospital Care During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations

Contact Info

Product

Resources

About