51
|
D'Anna L, Brown M, Oishi S, Ellis N, Brown Z, Bentley P, Drumm B, Halse O, Jamil S, Jenkins H, Malik A, Kalladka D, Venter M, Kwan J, Banerjee S. Impact of National Lockdown on the Hyperacute Stroke Care and Rapid Transient Ischaemic Attack Outpatient Service in a Comprehensive Tertiary Stroke Centre During the COVID-19 Pandemic. Front Neurol 2021; 12:627493. [PMID: 33679589 PMCID: PMC7928343 DOI: 10.3389/fneur.2021.627493] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/08/2021] [Indexed: 01/09/2023] Open
Abstract
Background: The COVID-19 pandemic is having major implications for stroke services worldwide. We aimed to study the impact of the national lockdown period during the COVID-19 outbreak on stroke and transient ischemic attack (TIA) care in London, UK. Methods: We retrospectively analyzed data from a quality improvement registry of consecutive patients presenting with acute ischemic stroke and TIA to the Stroke Department, Imperial College Health Care Trust London during the national lockdown period (between March 23rd and 30th June 2020). As controls, we evaluated the clinical reports and stroke quality metrics of patients presenting with stroke or TIA in the same period of 2019. Results: Between March 23rd and 30th June 2020, we documented a fall in the number of stroke admissions by 31.33% and of TIA outpatient referrals by 24.44% compared to the same period in 2019. During the lockdown, we observed a significant increase in symptom onset-to-door time in patients presenting with stroke (median = 240 vs. 160 min, p = 0.020) and TIA (median = 3 vs. 0 days, p = 0.002) and a significant reduction in the total number of patients thrombolysed [27 (11.49%) vs. 46 (16.25%, p = 0.030)]. Patients in the 2020 cohort presented with a lower median pre-stroke mRS (p = 0.015), but an increased NIHSS (p = 0.002). We registered a marked decrease in mimic diagnoses compared to the same period of 2019. Statistically significant differences were found between the COVID and pre-COVID cohorts in the time from onset to door (median 99 vs. 88 min, p = 0.026) and from onset to needle (median 148 vs. 126 min, p = 0.036) for thrombolysis whilst we did not observe any significant delay to reperfusion therapies (door-to-needle and door-to-groin puncture time). Conclusions: National lockdown in the UK due to the COVID-19 pandemic was associated with a significant decrease in acute stroke admission and TIA evaluations at our stroke center. Moreover, a lower proportion of acute stroke patients in the pandemic cohort benefited from reperfusion therapy. Further research is needed to evaluate the long-term effects of the pandemic on stroke care.
Collapse
Affiliation(s)
- Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Maddison Brown
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Sikdar Oishi
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Natalya Ellis
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Zoe Brown
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Paul Bentley
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Brian Drumm
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Omid Halse
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Sohaa Jamil
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Harri Jenkins
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Abid Malik
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Dheeraj Kalladka
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Marius Venter
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Joseph Kwan
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Soma Banerjee
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| |
Collapse
|
52
|
Effect of the COVID-19 pandemic and the lockdown measures on the local stroke network. Neurol Sci 2021; 42:1237-1245. [PMID: 33452656 PMCID: PMC7810284 DOI: 10.1007/s10072-021-05045-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
Introduction The COVID-19 outbreak highly impacted the acute ischemic stroke care management. The primary end point of the study was to evaluate the impact of the COVID-19 outbreak and the following lockdown measures on our hub-and-spoke network; the secondary end point was to evaluate if the impact of the COVID-19 outbreak was different in hub-and-spoke centers. Methods This was a retrospective multicenter observational study conducted at the Stroke Units of Policlinico Gemelli, Ospedale San Filippo Neri, Ospedale di Belcolle, and Ospedale San Camillo de Lellis. We collected clinical reports of all consecutive patients admitted with diagnosis of acute ischemic stroke or transient ischemic attack (TIA) during the phase 1 of the lockdown period (11 March 2020–4 May 2020). As controls, we used all consecutive patients admitted for acute ischemic stroke or TIA in the same period of the previous year. Results A total of 156 and 142 clinical reports were collected in 2019 and 2020, respectively. During the COVID-19 outbreak, we observed a reduction of number of thrombolysis, a reduction of the length of hospitalization, and an increase of pneumonia. Regarding performance indicators, we observed an increase in onset-to-door time and in door-to-groin time. We did not observe any statistically significant interaction between year (2019 vs 2020) and facility of admission (hub vs spoke) on all variables analyzed. Discussion Our observational study, involving hub-and-spoke stroke network of a wide regional area, indicates that the COVID-19 outbreak impacted on the acute stroke management. This impact was equally observed in hub as well as in spoke centers.
Collapse
|
53
|
Ramírez-Moreno JM, Portilla-Cuenca JC, Hariramani-Ramchandani R, Rebollo B, Bermejo Casado I, Macías-Sedas P, Ceberino D, Roa-Montero AM, González-Plata A, Casado I, Fernández de Alarcón L. Slump in Hospital Admissions for Stroke, a Fact of an Uncertain Nature That Requires Explanation. Brain Sci 2021; 11:brainsci11010092. [PMID: 33450843 PMCID: PMC7828369 DOI: 10.3390/brainsci11010092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 01/17/2023] Open
Abstract
(1) Background: The impact of the health crisis caused by coronavirus disease 2019 (COVID-19) has provoked collateral effects in the attention to pathologies with time-dependent treatments such as strokes. We compare the healthcare activity of two stroke units in the same periods of 2019 and 2020, with an emphasis on what happened during the state of alarm (SA). (2) Materials and methods. Hospitals in the region implemented contingency plans to contain the pandemic; in this planning, the stroke units were not limited in their operational capacity. The SA was declared on 15 March and remained in place for 10 weeks. For the analysis, the data were grouped by consecutive calendar weeks. (3) Results. When the SA was declared the number of calls to the emergency telephone went from 1225 to 3908 calls per week (318% increase). However, the activation of the stroke code went from 6.6 to 5.0 (p = 0.04) and the activity in both stroke units decreased. The largest drop in hospitalizations was for transient ischemic attacks (TIAs) with 35.7% less, 28 vs. 18, (p = 0.05). Reperfusion therapies fell by 37.5%; Poisson regression model 0.64; (95% confidence interval (CI), 0.43–0.95). The overall activity of the telestroke suffered a reduction of 28.9%. We also observed an increase in hospital mortality. (4) Conclusion. The excessive duration of the pandemic precludes any hope of resolving this public health crisis in the short or medium term. Further studies should be conducted to better understand the multifactorial nature of this dramatic decline in stroke admissions and its negative impact.
Collapse
Affiliation(s)
- José M. Ramírez-Moreno
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
- Department of Biomedical Sciences, Extremadura University, 06080 Badajoz, Spain
- Multidisciplinary Research Group of Extremadura (GRIMEX), 06700 Villanueva de la Serena, Spain
- University Institute of Biosanitary Research of Extremadura (INUBE), 06080 Badajoz, Spain;
- Correspondence:
| | | | - Roshan Hariramani-Ramchandani
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - Belen Rebollo
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - Inés Bermejo Casado
- Department of Neurology, University Hospital of Cáceres, 10003 Cáceres, Spain; (J.C.P.-C.); (I.B.C.)
| | - Pablo Macías-Sedas
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - David Ceberino
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - Ana M. Roa-Montero
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - Alberto González-Plata
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - Ignacio Casado
- University Institute of Biosanitary Research of Extremadura (INUBE), 06080 Badajoz, Spain;
- Department of Neurology, University Hospital of Cáceres, 10003 Cáceres, Spain; (J.C.P.-C.); (I.B.C.)
| | | |
Collapse
|
54
|
Tsivgoulis G, Palaiodimou L, Zand R, Lioutas VA, Krogias C, Katsanos AH, Shoamanesh A, Sharma VK, Shahjouei S, Baracchini C, Vlachopoulos C, Gournellis R, Sfikakis PP, Sandset EC, Alexandrov AV, Tsiodras S. COVID-19 and cerebrovascular diseases: a comprehensive overview. Ther Adv Neurol Disord 2020; 13:1756286420978004. [PMID: 33343709 PMCID: PMC7727052 DOI: 10.1177/1756286420978004] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ to alarm clinicians in recognizing COVID-19-related stroke.
Collapse
Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, National & Kapodistrian University of Athens, Rimini 1, Chaidari, Athens 12462, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, 'Attikon' University Hospital, Athens, Greece
| | - Ramin Zand
- Department of Neurology, Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | | | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Aristeidis H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, 'Attikon' University Hospital, Athens, Greece
| | - Ashkan Shoamanesh
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, YLL School of Medicine, National University of Singapore, Singapore
| | - Shima Shahjouei
- Department of Neurology, Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | | | - Rossetos Gournellis
- Second Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, 'Attikon' University Hospital, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andrei V Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
55
|
Nef HM, Elsässer A, Möllmann H, Abdel-Hadi M, Bauer T, Brück M, Eggebrecht H, Ehrlich JR, Ferrari MW, Fichtlscherer S, Hink U, Hölschermann H, Kacapor R, Koeth O, Korboukov S, Lamparter S, Laspoulas AJ, Lehmann R, Liebetrau C, Plücker T, Pons-Kühnemann J, Schächinger V, Schieffer B, Schott P, Schulze M, Teupe C, Vasa-Nicotera M, Weber M, Weinbrenner C, Werner G, Hamm CW, Dörr O. Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study. Clin Res Cardiol 2020; 110:292-301. [PMID: 33219854 PMCID: PMC7680078 DOI: 10.1007/s00392-020-01780-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Aims During the COVID-19 pandemic, hospital admissions for cardiac care have declined. However, effects on mortality are unclear. Thus, we sought to evaluate the impact of the lockdown period in central Germany on overall and cardiovascular deaths. Simultaneously we looked at catheterization activities in the same region. Methods and results Data from 22 of 24 public health-authorities in central Germany were aggregated during the pandemic related lockdown period and compared to the same time period in 2019. Information on the total number of deaths and causes of death, including cardiovascular mortality, were collected. Additionally, we compared rates of hospitalization (n = 5178) for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and out of hospital cardiac arrest (OHCA) in 26 hospitals in this area. Data on 5,984 deaths occurring between March 23, 2020 and April 26, 2020 were evaluated. In comparison to the reference non-pandemic period in 2019 (deaths: n = 5832), there was a non-significant increase in all-cause mortality of 2.6% [incidence rate ratio (IRR) 1.03, 95% confidence interval (CI) 0.99–1.06; p = 0.16]. Cardiovascular and cardiac mortality increased significantly by 7.6% (IRR 1.08, 95%-CI 1.01–1.14; p = 0.02) and by 11.8% (IRR 1.12, 95%-CI 1.05–1.19; p < 0.001), respectively. During the same period, our data revealed a drop in cardiac catherization procedures. Conclusion During the COVID-19-related lockdown a significant increase in cardiovascular mortality was observed in central Germany, whereas catherization activities were reduced. The mechanisms underlying both of these observations should be investigated further in order to better understand the effects of a pandemic-related lockdown and social-distancing restrictions on cardiovascular care and mortality. Graphic abstract ![]()
Collapse
Affiliation(s)
- Holger M Nef
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany. .,Department of Cardiology, Herz-Kreislauf-Zentrum Klinikum Hersfeld-Rotenburg, Rotenburg, Germany.
| | | | - Helge Möllmann
- St.-Johannes-Hospital Klinik Für Innere Medizin I, Dortmund, Germany
| | | | - Timm Bauer
- Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Martin Brück
- Department of Cardiology, Lahn-Dill-Kliniken, Klinikum Wetzlar, Wetzlar, Germany
| | - Holger Eggebrecht
- Department of Cardiology, Agaplesion Frankfurter Diakonie Kliniken, Frankfurt, Germany
| | - Joachim R Ehrlich
- Department of Cardiology, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Markus W Ferrari
- Department of Cardiology, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, Herz-Kreislauf-Zentrum Klinikum Hersfeld-Rotenburg, Rotenburg, Germany
| | - Ulrich Hink
- Department of Cardiology, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany
| | | | - Rifat Kacapor
- Department of Cardiology, Kliniken Des Main-Taunus-Kreises, Bad Soden am Taunus, Germany
| | - Oliver Koeth
- Department of Cardiology, GPR Gesundheits- Und Pflegezentrum Rüsselsheim, Rüsselsheim, Germany
| | | | - Steffen Lamparter
- Department of Cardiology, Diakonie-Krankenhaus Wehrda, Marburg, Germany
| | - Alexander J Laspoulas
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany
| | - Ralf Lehmann
- Department of Cardiology, Asklepios Kliniken Langen, Langen, Germany
| | | | - Tobias Plücker
- Department of Cardiology, Eichhof-Stiftung Lauterbach, Lauterbach, Germany
| | - Jörn Pons-Kühnemann
- Justus Liebig University Giessen, Medical Statistics, Institute of Medical Informatics, Giessen, Germany
| | | | - Bernhard Schieffer
- Department of Internal Medicine/Cardiology and Angiology, University Hospital of Marburg, Marburg, Germany
| | - Peter Schott
- Department of Cardiology, Klinikum Werra Meissner GmbH, Eschwege, Germany
| | - Matthias Schulze
- Department of Cardiology, Asklepios Schwalm-Eder-Kliniken, Schwalmstadt, Germany
| | - Claudius Teupe
- Department of Cardiology, Krankenhaus Sachsenhausen, Frankfurt am Main, Germany
| | | | - Michael Weber
- Department of Cardiology, Kreisklinik Groß-Umstadt, Groß-Umstadt, Germany
| | | | - Gerald Werner
- Department of Cardiology, Klinikum Darmstadt, Darmstadt, Germany
| | - Christian W Hamm
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Oliver Dörr
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany
| | | |
Collapse
|
56
|
Dula AN, Gealogo Brown G, Aggarwal A, Clark KL. Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go? JMIR Aging 2020; 3:e21608. [PMID: 33006936 PMCID: PMC7581311 DOI: 10.2196/21608] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/18/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022] Open
Abstract
Despite the evidence suggesting a high rate of cerebrovascular complications in patients with SARS-CoV-2, reports have indicated decreasing rates of new ischemic stroke diagnoses during the COVID-19 pandemic. The observed decrease in emergency department (ED) visits is unsurprising during this major crisis, as patients are likely to prioritize avoiding exposure to SARS-CoV-2 over addressing what they may perceive as mild symptoms of headache, lethargy, difficulty speaking, and numbness. In the central and south Texas regions where we practice, we suspect that patient admission, treatment, and discharge volumes for acute stroke treatment have decreased significantly since COVID-19–related shelter-at-home orders were issued. Symptoms of stroke are frequently noticed by a family member, friend, or community member before they are recognized by the patients themselves, and these symptoms may be going unnoticed due to limited face-to-face encounters. This possibility emphasizes the importance of patient education regarding stroke warning signs and symptoms during the current period of isolation and social-distancing. The south Texas population, already saddled with above-average rates of cardiovascular and cerebrovascular disease, has a higher stroke mortality rate compared to Texas and U.S. averages; however, the number of patients presenting to EDs with acute ischemic stroke diagnoses is lower than average. In our viewpoint, we aim to present the relative literature to date and outline our ongoing analyses of the highly affected and diverse stroke populations in San Antonio and Austin, Texas, to answer a simple question: where did all our stroke patients go?
Collapse
Affiliation(s)
- Adrienne Nicole Dula
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States.,Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Gretchel Gealogo Brown
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Aarushi Aggarwal
- Long School of Medicine, University of Texas Health, San Antonio, TX, United States
| | - Kal L Clark
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| |
Collapse
|
57
|
Abd-alrazaq A, Schneider J, Mifsud B, Alam T, Househ M, Hamdi M, Shah Z. A Comprehensive Overview of the COVID-19 Literature: Machine Learning–Based Bibliometric Analysis (Preprint).. [DOI: 10.2196/preprints.23703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Shortly after the emergence of COVID-19, researchers rapidly mobilized to study numerous aspects of the disease such as its evolution, clinical manifestations, effects, treatments, and vaccinations. This led to a rapid increase in the number of COVID-19–related publications. Identifying trends and areas of interest using traditional review methods (eg, scoping and systematic reviews) for such a large domain area is challenging.
OBJECTIVE
We aimed to conduct an extensive bibliometric analysis to provide a comprehensive overview of the COVID-19 literature.
METHODS
We used the COVID-19 Open Research Dataset (CORD-19) that consists of a large number of research articles related to all coronaviruses. We used a machine learning–based method to analyze the most relevant COVID-19–related articles and extracted the most prominent topics. Specifically, we used a clustering algorithm to group published articles based on the similarity of their abstracts to identify research hotspots and current research directions. We have made our software accessible to the community via GitHub.
RESULTS
Of the 196,630 publications retrieved from the database, we included 28,904 in our analysis. The mean number of weekly publications was 990 (SD 789.3). The country that published the highest number of COVID-19–related articles was China (2950/17,270, 17.08%). The highest number of articles were published in bioRxiv. Lei Liu affiliated with the Southern University of Science and Technology in China published the highest number of articles (n=46). Based on titles and abstracts alone, we were able to identify 1515 surveys, 733 systematic reviews, 512 cohort studies, 480 meta-analyses, and 362 randomized control trials. We identified 19 different topics covered among the publications reviewed. The most dominant topic was public health response, followed by clinical care practices during the COVID-19 pandemic, clinical characteristics and risk factors, and epidemic models for its spread.
CONCLUSIONS
We provide an overview of the COVID-19 literature and have identified current hotspots and research directions. Our findings can be useful for the research community to help prioritize research needs and recognize leading COVID-19 researchers, institutes, countries, and publishers. Our study shows that an AI-based bibliometric analysis has the potential to rapidly explore a large corpus of academic publications during a public health crisis. We believe that this work can be used to analyze other eHealth-related literature to help clinicians, administrators, and policy makers to obtain a holistic view of the literature and be able to categorize different topics of the existing research for further analyses. It can be further scaled (for instance, in time) to clinical summary documentation. Publishers should avoid noise in the data by developing a way to trace the evolution of individual publications and unique authors.
Collapse
|