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Al Qawasmeh M, Ahmed YB, Nsour OA, Qarqash AA, Al-Horani SS, Hazaimeh EA, Jbarah OF, Yassin A, Aldabbour B, Alhusban A, El-Salem K. Functional outcomes of COVID-19 patients with acute ischemic stroke: A prospective, observational, single-center study in North Jordan. Medicine (Baltimore) 2022; 101:e29834. [PMID: 35777044 PMCID: PMC9239634 DOI: 10.1097/md.0000000000029834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We assessed whether stroke severity, functional outcome, and mortality in patients with ischemic stroke differed between patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and those without. We conducted a prospective, single-center cohort study in Irbid, North Jordan. All patients diagnosed with ischemic stroke and SARS-CoV-2 infection were consecutively recruited from October 15, 2020, to October 16, 2021. We recorded demographic data, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, stroke subtype according to the Trial of ORG 10172 in Acute Stroke Treatment Criteria (TOAST), treatments at admission, and laboratory variables for all patients. The primary endpoint was the functional outcome at 3 months assessed using the modified Rankin Score. Secondary outcomes involved in-hospital mortality and mortality at 3 months. We included 178 patients with a mean (standard deviation) age of 67.3 (12), and more than half of the cases were males (96/178; 53.9%). Thirty-six cases were coronavirus disease 2019 (COVID-19) related and had a mean (standard deviation) age of 70 (11.5). When compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a higher median NIHSS score at baseline (6 vs 11; P = .043), after 72 hours (6 vs 12; P = .006), and at discharge (4 vs 16; P < .001). They were also more likely to have a higher median modified Rankin Score after 3 months of follow-up (P < .001). NIHSS score at admission (odds ratio = 1.387, 95% confidence interval = 1.238-1.553]; P < .001) predicted having an unfavorable outcome after 3 months. On the other hand, having a concomitant SARS-CoV-2 infection did not significantly impact the likelihood of unfavorable outcomes (odds ratio = 1.098, 95% confidence interval = 0.270-4.473; P = .896). The finding conclude that SARS-CoV-2 infection led to an increase in both stroke severity and in-hospital mortality but had no significant impact on the likelihood of developing unfavorable outcomes.
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Affiliation(s)
- Majdi Al Qawasmeh
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yaman B. Ahmed
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- * Correspondence: Yaman B. Ahmed, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan (e-mail: )
| | - Omar A. Nsour
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aref A. Qarqash
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sami S. Al-Horani
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ethar A. Hazaimeh
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F. Jbarah
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmed Yassin
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Belal Aldabbour
- Neuroscience Department, Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Ahmed Alhusban
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Burns SP, Fleming TK, Webb SS, Kam ASH, Fielder JDP, Kim GJ, Hu X, Hill MT, Kringle EA. Stroke Recovery During the COVID-19 Pandemic: A Position Paper on Recommendations for Rehabilitation. Arch Phys Med Rehabil 2022; 103:1874-1882. [PMID: 35533736 PMCID: PMC9072806 DOI: 10.1016/j.apmr.2022.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/02/2022]
Abstract
Health care delivery shifted and adapted with the COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus 2. Stroke care was negatively affected across the care continuum and may lead to poor community living outcomes in those who survived a stroke during the ongoing pandemic. For instance, delays in seeking care, changes in length of stays, and shifts in discharge patterns were observed during the pandemic. Those seeking care were younger and had more severe neurologic effects from stroke. Increased strain was placed on caregivers and public health efforts, and community-wide lockdowns, albeit necessary to reduce the spread of COVID-19, had detrimental effects on treatment and recommendations to support community living outcomes. The American Congress of Rehabilitation Medicine Stroke Interdisciplinary Special Interest Group Health and Wellness Task Force convened to (1) discuss international experiences in stroke care and rehabilitation and (2) review recently published literature on stroke care and outcomes during the pandemic. Based on the findings in the literature, the task force proposes recommendations and interdisciplinary approaches at the (1) institutional and societal level; (2) health care delivery level; and (3) individual and interpersonal level spanning across the care continuum and into the community.
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Affiliation(s)
- Suzanne Perea Burns
- Division of Occupational Therapy, University of New Mexico School of Medicine, Albuquerque, New Mexico.
| | - Talya K Fleming
- JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, New Jersey
| | - Sam S Webb
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Alice Sau Han Kam
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada; Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
| | | | - Grace J Kim
- Department of Occupational Therapy, New York University, New York City, New York; Department of Rehabilitation Medicine, NYU Langone Health, New York City, New York
| | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Mary Thelander Hill
- Division of Occupational Therapy, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Emily A Kringle
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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Simonetto M, Wechsler PM, Merkler AE. Stroke Treatment in the Era of COVID-19: a Review. Curr Treat Options Neurol 2022; 24:155-171. [PMID: 35497091 PMCID: PMC9035774 DOI: 10.1007/s11940-022-00713-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/15/2022]
Abstract
Purpose of Review To describe a comprehensive review of the epidemiology, pathophysiology, and treatment of stroke in the era of COVID-19. Recent Findings COVID-19 is associated with myriad neurological disorders, including cerebrovascular disease. While ischemic stroke is the most common, COVID-19 is associated with an increased risk of intracranial hemorrhage, arterial dissection, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis. In this review, we discuss the epidemiology, pathophysiology, and treatment of stroke due to COVID-19. In addition, we describe how COVID-19 has changed the landscape of stroke systems of care and the effect this has had on patients with cerebrovascular disease. Summary While COVID-19 is associated with a heightened risk of stroke, the pandemic has led to advances in stroke systems of care that may reduce the long-term burden of stroke.
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Affiliation(s)
- Marialaura Simonetto
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, Room F610, 525 East 68th Street, New York, NY 10065 USA
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY USA
| | - Paul M. Wechsler
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, Room F610, 525 East 68th Street, New York, NY 10065 USA
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY USA
| | - Alexander E. Merkler
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, Room F610, 525 East 68th Street, New York, NY 10065 USA
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY USA
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Ischemic Stroke and SARS-CoV-2 Infection: The Bidirectional Pathology and Risk Morbidities. Neurol Int 2022; 14:391-405. [PMID: 35645351 PMCID: PMC9149929 DOI: 10.3390/neurolint14020032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 12/12/2022] Open
Abstract
Stroke is a fatal morbidity that needs emergency medical admission and immediate medical attention. COVID-19 ischemic brain damage is closely associated with common neurological symptoms, which are extremely difficult to treat medically, and risk factors. We performed literature research about COVID-19 and ischemia in PubMed, MEDLINE, and Scopus for this current narrative review. We discovered parallel manifestations of SARS-CoV-19 infection and brain ischemia risk factors. In published papers, we discovered a similar but complex pathophysiology of SARS-CoV-2 infection and stroke pathology. A patient with other systemic co-morbidities, such as diabetes, hypertension, or any respiratory disease, has a fatal combination in intensive care management when infected with SARS-CoV-19. Furthermore, due to their shared risk factors, COVID-19 and stroke are a lethal combination for medical management to treat. In this review, we discuss shared pathophysiology, adjuvant risk factors, challenges, and advancements in stroke-associated COVID-19 therapeutics.
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Medina-Rioja R, González-Calderón G, Saldívar-Dávila S, Estrada Saúl A, Gayón-Lombardo E, Somerville-Briones N, Calleja-Castillo JM. Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City. Front Neurol 2022; 13:831735. [PMID: 35463140 PMCID: PMC9020365 DOI: 10.3389/fneur.2022.831735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
Stroke is one of the leading causes of death and disability among adults worldwide. The World Health Organization (WHO) officially declared a COVID-19 pandemic on March 11, 2020. The first case in Mexico was confirmed in February 2020, subsequently becoming one of the countries most affected by the pandemic. In 2020, The National Institute of Neurology of Mexico started a Quality assurance program for stroke care, consisting of registering, monitoring and feedback of stroke quality measures through the RES-Q platform. We aim to describe changes in the demand for stroke healthcare assistance at the National Institute of Neurology and Neurosurgery during the pandemic and the behavior of stroke quality metrics during the prepandemic and the pandemic periods. For this study, we analyzed data for acute stroke patients registered in the RES-Q platform, in the prepandemic (November 2019 to February 2020) and pandemic (March-December 2020) periods in two groups, one prior to the pandemic. During the pandemic, there was an increase in the total number of assessed acute stroke patients at our hospital, from 474 to 574. The average time from the onset of symptoms to hospital arrival (Onset to Door Time—OTD) for all stroke patients (thrombolyzed and non-thrombolyzed) increased from 9 h (542 min) to 10.3 h (618.3 min) in the pandemic group. A total of 135 acute stroke patients were enrolled in this registry. We found the following results: Patients in both groups were studied with non-contrast computed tomography (NNCT), computed tomography angiography (CTA), magnetic resonance angiography (MRA), digital subtraction angiography (DSA) or more frequently in the pandemic period (early carotid imaging, Holter monitoring) as needed. Treatment for secondary prevention (antihypertensives, antiplatelets, statins) did not differ. Frequency of performing and documenting the performance of NIHSS scale at arrival and early dysphagia test improved. There was an increase in alteplase use from 21 to 42% (p = 0.03). There was a decrease in door to needle time (46 vs. 39 min p = 0.30). After the implementation of a stroke care protocol and quality monitoring system, acute stroke treatment in our institution has gradually improved, a process that was not thwarted during the COVID-19 pandemic.
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6
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Miller ET, Hinkle JL. Nursing's Contributions to Stroke Care During COVID-19. Stroke 2022; 53:1396-1398. [PMID: 35236089 DOI: 10.1161/strokeaha.122.037447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Janice L Hinkle
- M. Louise Fitzpatrick College of Nursing, Villanova University, Philadelphia, PA (J.L.H.)
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7
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Pandain JD, Panagos PD, Sebastian IA, Silva GS, Furie KL, Liu L, Owolabi MO, Caso V, Alrukn SA. Maintaining Stroke Care During the COVID-19 Pandemic in Lower- and Middle-Income Countries: World Stroke Organization Position Statement Endorsed by American Stroke Association and American Heart Association. Stroke 2022; 53:1043-1050. [DOI: 10.1161/str.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
For more than a year, the SARS-CoV-2 pandemic has had a devastating effect on global health. High-, low, and middle-income countries are struggling to cope with the spread of newer mutant strains of the virus. Delivery of acute stroke care remains a priority despite the pandemic. In order to maintain the time-dependent processes required to optimize delivery of intravenous thrombolysis and endovascular therapy, most countries have reorganized infrastructure to optimize human resources and critical services. Low-and-middle income countries (LMIC) have strained medical resources at baseline and often face challenges in the delivery of stroke systems of care (SSOC). This position statement aims to produce pragmatic recommendations on methods to preserve the existing SSOC during COVID-19 in LMIC and propose best stroke practices that may be low cost but high impact and commonly shared across the world.
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Affiliation(s)
- Jeyaraj D. Pandain
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India (J.D.P.)
| | - Peter D. Panagos
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO (P.D.P.)
| | - Ivy A. Sebastian
- Department of Neurology, St Stephens Hospital, New Delhi, India (I.A.S.)
| | - Gisele Sampaio Silva
- Department of Neurology, Federal University of São Paulo, Clinical Trialist/Neurology, Albert Einstein Hospital, São Paulo, Brazil (G.S.S.)
| | - Karen L. Furie
- Department of Neurology, Rhode Island Hospital Chair of Neurology, The Warren Alpert Medical School of Brown University, Providence (K.L.F.)
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (L.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (L.L.)
| | - Mayowa O. Owolabi
- Department of Neurology, Faculty of Clinical Sciences, Director, Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria (M.O.O.)
| | - Valeria Caso
- Department of Neurology, Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Italy (V.C.)
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8
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Kim PH, Kim M, Suh CH, Chung SR, Park JE, Kim SC, Choi YJ, Lee JH, Kim HS, Baek JH, Choi CG, Kim SJ. Neuroimaging Findings in Patients with COVID-19: A Systematic Review and Meta-Analysis. Korean J Radiol 2021; 22:1875-1885. [PMID: 34269530 PMCID: PMC8546134 DOI: 10.3348/kjr.2021.0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/31/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Central nervous system involvement in coronavirus disease 2019 (COVID-19) has been increasingly reported. We performed a systematic review and meta-analysis to evaluate the incidence of radiologically demonstrated neurologic complications and detailed neuroimaging findings associated with COVID-19. MATERIALS AND METHODS A systematic literature search of MEDLINE/PubMed and EMBASE databases was performed up to September 17, 2020, and studies evaluating neuroimaging findings of COVID-19 using brain CT or MRI were included. Several cohort-based outcomes, including the proportion of patients with abnormal neuroimaging findings related to COVID-19 were evaluated. The proportion of patients showing specific neuroimaging findings was also assessed. Subgroup analyses were also conducted focusing on critically ill COVID-19 patients and results from studies that used MRI as the only imaging modality. RESULTS A total of 1394 COVID-19 patients who underwent neuroimaging from 17 studies were included; among them, 3.4% of the patients demonstrated COVID-19-related neuroimaging findings. Olfactory bulb abnormalities were the most commonly observed (23.1%). The predominant cerebral neuroimaging finding was white matter abnormality (17.6%), followed by acute/subacute ischemic infarction (16.0%), and encephalopathy (13.0%). Significantly more critically ill patients had COVID-19-related neuroimaging findings than other patients (9.1% vs. 1.6%; p = 0.029). The type of imaging modality used did not significantly affect the proportion of COVID-19-related neuroimaging findings. CONCLUSION Abnormal neuroimaging findings were occasionally observed in COVID-19 patients. Olfactory bulb abnormalities were the most commonly observed finding. Critically ill patients showed abnormal neuroimaging findings more frequently than the other patient groups. White matter abnormalities, ischemic infarctions, and encephalopathies were the common cerebral neuroimaging findings.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Minjae Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo Chin Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choong Gon Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Pandian JD, Panagos PD, Sebastian IA, Sampaio Silva G, Furie KL, Liu L, Owolabi MO, Caso V, Alrukn SA. Maintaining stroke care during the COVID-19 pandemic in lower- and middle-income countries: World Stroke Organization Position Statement endorsed by American Stroke Association and American Heart Association. Int J Stroke 2021; 17:9-17. [PMID: 34711104 DOI: 10.1177/17474930211055878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For more than a year, the SARS-CoV-2 pandemic has had a devastating effect on global health. High-, low-, and middle-income countries are struggling to cope with the spread of newer mutant strains of the virus. Delivery of acute stroke care remains a priority despite the pandemic. In order to maintain the time-dependent processes required to optimize delivery of intravenous thrombolysis and endovascular therapy, most countries have reorganized infrastructure to optimize human resources and critical services. Low-and-middle income countries (LMIC) have strained medical resources at baseline and often face challenges in the delivery of stroke systems of care (SSOC). This position statement aims to produce pragmatic recommendations on methods to preserve the existing SSOC during COVID-19 in LMIC and propose best stroke practices that may be low cost but high impact and commonly shared across the world.
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Affiliation(s)
- Jeyaraj D Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Peter D Panagos
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Ivy A Sebastian
- Department of Neurology, St Stephens Hospital, New Delhi, India
| | - Gisele Sampaio Silva
- Department of Neurology, Federal University of São Paulo, Clinical Trialist/Neurology, Albert Einstein Hospital, São Paulo, Brazil
| | - Karen L Furie
- Department of Neurology, Rhode Island Hospital Chair of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mayowa O Owolabi
- Department of Neurology, Faculty of Clinical Sciences, Director, Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Valeria Caso
- Department of Neurology, Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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10
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Sheng S, Wang X, Gil Tommee C, Arulprakash N, Kamran M, Shah V, Jasti M, Yadala S, Brown A, Onteddu S, Nalleballe K. Continued Underutilization of stroke care during the COVID-19 pandemic. Brain Behav Immun Health 2021; 15:100274. [PMID: 34589777 PMCID: PMC8474631 DOI: 10.1016/j.bbih.2021.100274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 11/20/2022] Open
Abstract
Objective This study aims to investigate the utilization of acute ischemic stroke (AIS) services during the Corona Virus Disease 2019 (COVID-19) pandemic. Based on early observations among healthcare utilization on stroke and other healthcare services, we hypothesized that there would be a persistent significant decline in AIS patients presenting to hospitals as the pandemic has progressed for over a year. Method TriNetX, a large research network, is used to collect real-time electronic medical data. Data on utilization of acute ischemic stroke service was collected for the years 2018, 2019, and 2020 for variables including overall stroke volume and the number of patients that received intravenous tissue plasminogen activator (tPA) and mechanical thrombectomy (MT). Result We found a 13.2–15.4% decrease in total number of AIS patients in 2020 (n 77231) compared with the years 2018 and 2019 (n 88948 and 91270 respectively, p < 0.001). In the year 2020 Stroke volume was significantly lower in Q4 comparing to Q1 (Q1 vs Q4, p < 0.01, while there were no significant differences in stroke volume between Quarters 2, 3, and 4 in 2020 (Q2 vs Q3, p = 0.39, Q2 vs Q4, p = 0.61, Q3 vs Q4, p = 0.18). The Proportion of patients receiving tPA in 2020 was significantly lower compared to prior years (5.4% in 2020 vs 6.4% in 2018 and 6.0% in 2019, p < 0.01), however, the proportion of patients receiving MT was significantly higher in 2020 than in 2018 (0.024 vs 0.022, p < 0.01). Conclusion Despite significant alteration in practices to optimize healthcare delivery and mitigate the collateral impact of the pandemic on care for other conditions, a persistent decline in AIS volumes remains. Delayed presentation, fear-of-contagion, reallocation, and poor availability of health care resources are potential contributors. Prospective evaluation and further investigation for these trends is needed.
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Affiliation(s)
- Sen Sheng
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Corresponding author. Department of Neurology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 500, Little Rock, AR 72205, USA.
| | - Xixi Wang
- Department of Mathematics and Statistics, University of Arkansas in Little Rock, Little Rock, AR, USA
| | - Carolina Gil Tommee
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Naren Arulprakash
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mudassar Kamran
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Vishank Shah
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Madhu Jasti
- University of Maryland, Baltimore Washington Medical Center, USA
| | - Sisira Yadala
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aliza Brown
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sanjeeva Onteddu
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Krishna Nalleballe
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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11
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Yoshimoto T, Shiozawa M, Koge J, Inoue M, Koga M, Ihara M, Toyoda K. Evaluation of Workflow Delays in Stroke Reperfusion Therapy: A Comparison between the Year-Long Pre-COVID-19 Period and the with-COVID-19 Period. J Atheroscler Thromb 2021; 29:1095-1107. [PMID: 34393139 PMCID: PMC9252617 DOI: 10.5551/jat.63090] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: We evaluated the delay in stroke reperfusion therapy between the pre-coronavirus disease 2019 (COVID-19) period and the with-COVID-19 period, and compared this delay between each phase of the with-COVID-19 period.
Methods: Patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis and/or mechanical thrombectomy were selected from our single-center prospective registry. The time to perform reperfusion therapy were compared between patients admitted from March 2019 to February 2020 (pre-COVID-19 group) and those from March 2020 to February 2021 (with-COVID-19 group). Patients in the with-COVID-19 group were further divided into three 4-month-long subgroups (first-phase: March to June 2020; second-phase: July to October 2020; third-phase: November 2020 to February 2021), and the time delay of reperfusion therapy were compared between these subgroups.
Results: Of 1,260 patients with AIS hospitalized in the study period, 265 patients were examined. Compared with the pre-COVID-19 group (133 patients; median age, 79 years), the with-COVID-19 group (132 patients; median age, 79 years) had a longer median door-to-imaging time (25 min vs. 27 min,P=0.04), and a longer door-to-groin puncture time (65 min vs. 72 min,P=0.02). In the three 4-month-long subgroups, the median door-to-needle time (49 min, 43 min, and 38 min, respectively;P=0.04) and door-to-groin puncture time (83 min, 70 min, and 61 min,P<0.01, respectively) decreased significantly during the with-COVID-19 period.
Conclusions: The delay in reperfusion therapy increased during the with-COVID-19 period compared with
the pre-COVID-19 period. However, the door-to-needle time and door-to-groin puncture time decreased as time elapsed during the
with-COVID-19 period. ClinicalTrials.gov Identifier: NCT02251665
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Affiliation(s)
- Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center.,Division of Stroke Care Unit, National Cerebral and Cardiovascular Center
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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12
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Affiliation(s)
- Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia (D.A.C.).,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria Australia (D.A.C.)
| | - Janet Prvu Bettger
- Duke Roybal Center on Aging, Margolis Center for Health Policy, and Department of Orthopaedics, Duke University, Durham, NC (J.P.B.)
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13
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Reddy ST, Satani N, Beauchamp JES, Selvaraj S, Rajan SS, Rahbar MH, Tahanan A, Kim S, Holder T, Jiang X, Chen L, Kamal H, Indupuru HKR, Wu T, Savitz SI. A meta-analysis of the global impact of the COVID-19 pandemic on stroke care & the Houston Experience. Ann Clin Transl Neurol 2021; 8:929-937. [PMID: 33616305 PMCID: PMC8014129 DOI: 10.1002/acn3.51322] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/28/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To review the global impact of the COVID-19 pandemic on stroke care-metrics and report data from a health system in Houston. METHODS We performed a meta-analysis of the published literature reporting stroke admissions, intracerebral hemorrhage (ICH) cases, number of thrombolysis (tPA) and thrombectomy (MT) cases, and time metrics (door to needle, DTN; and door to groin time, DTG) during the pandemic compared to prepandemic period. Within our hospital system, between January-June 2019 and January-June 2020, we compared the proportion of stroke admissions and door to tPA and MT times. RESULTS A total of 32,640 stroke admissions from 29 studies were assessed. Compared to prepandemic period, the mean ratio of stroke admissions during the pandemic was 70.78% [95% CI, 65.02%, 76.54%], ICH cases was 83.10% [95% CI, 71.01%, 95.17%], tPA cases was 81.74% [95% CI, 72.33%, 91.16%], and MT cases was 88.63% [95% CI, 74.12%, 103.13%], whereas DTN time was 104.48% [95% CI, 95.52%, 113.44%] and DTG was 104.30% [95% CI, 81.99%, 126.61%]. In Houston, a total of 4808 cases were assessed. There was an initial drop of ~30% in cases at the pandemic onset. Compared to 2019, there was a significant reduction in mild strokes (NIHSS 1-5) [N (%), 891 (43) vs 635 (40), P = 0.02]. There were similar mean (SD) (mins) DTN [44 (17) vs 42 (17), P = 0.14] but significantly prolonged DTG times [94 (15) vs 85 (20), P = 0.005] in 2020. INTERPRETATION The COVID-19 pandemic led to a global reduction in stroke admissions and treatment interventions and prolonged treatment time metrics.
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Affiliation(s)
- Sujan T. Reddy
- Department of NeurologyMercy HospitalFort SmithArkansasUSA
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical SchoolUniversity of Texas Health Science Center at HoustonTexasUSA
| | - Nikunj Satani
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical SchoolUniversity of Texas Health Science Center at HoustonTexasUSA
| | - Jennifer E. S. Beauchamp
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical SchoolUniversity of Texas Health Science Center at HoustonTexasUSA
- Cizik School of Nursing at UTHealth Department of ResearchHoustonTexasUSA
| | - Sudhakar Selvaraj
- Louis Faillace, MD, Department of Psychiatry and Behavioral SciencesMcGovern Medical SchoolUniversity of Texas Health Science Center at HoustonTexasUSA
| | - Suja S. Rajan
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical SchoolUniversity of Texas Health Science Center at HoustonTexasUSA
- Department of Management, Policy and Community HealthSchool of Public HealthUniversity of Texas Health Science Center at HoustonTexasUSA
| | - Mohammad H. Rahbar
- Biostatistics/Epidemiology/Research Design CoreCenter for Clinical and Translational SciencesUniversity of Texas Health Science Center at HoustonTexasUSA
| | - Amirali Tahanan
- Biostatistics/Epidemiology/Research Design CoreCenter for Clinical and Translational SciencesUniversity of Texas Health Science Center at HoustonTexasUSA
| | - Sori Kim
- Biostatistics/Epidemiology/Research Design CoreCenter for Clinical and Translational SciencesUniversity of Texas Health Science Center at HoustonTexasUSA
- Department of Biostatistics and Data ScienceSchool of Public HealthUniversity of Texas Health Science Center at HoustonTexasUSA
| | | | - Xiaoqian Jiang
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical SchoolUniversity of Texas Health Science Center at HoustonTexasUSA
| | - Luyao Chen
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical SchoolUniversity of Texas Health Science Center at HoustonTexasUSA
| | - Haris Kamal
- Department of NeurosurgeryWestchester Medical CenterNew YorkUSA
| | - Hari Kishan R. Indupuru
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical SchoolUniversity of Texas Health Science Center at HoustonTexasUSA
| | - Tzu‐Ching Wu
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical SchoolUniversity of Texas Health Science Center at HoustonTexasUSA
| | - Sean I. Savitz
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical SchoolUniversity of Texas Health Science Center at HoustonTexasUSA
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14
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Markus HS, Martins S. COVID-19 and stroke-Understanding the relationship and adapting services. A global World Stroke Organisation perspective. Int J Stroke 2021; 16:241-247. [PMID: 33709834 PMCID: PMC8044614 DOI: 10.1177/17474930211005373] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 01/14/2023]
Abstract
A year ago the World Stroke Organisation (WSO) highlighted the enormous global impact of the COVID-19 pandemic on stroke care. In this review, we consider a year later where we are now, what the future holds, and what the long-term effects of the pandemic will be on stroke. Stroke occurs in about 1.4% of patients hospitalized with COVID-19 infection, who show an excess of large vessel occlusion and increased mortality. Despite this association, stroke presentations fell dramatically during the pandemic, although emerging data suggest that total stroke mortality may have risen with increased stroke deaths at home and in care homes. Strategies and guidelines have been developed to adapt stroke services worldwide, and protect healthcare workers. Adaptations include increasing use of telemedicine for all aspects of stroke care. The pandemic is exacerbating already marked global inequalities in stroke incidence and mortality. Lastly, the pandemic has had a major impact on stroke research and funding, although it has also emphasized the importance of large scale collaborative research initiatives.
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Affiliation(s)
- Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Sheila Martins
- Department of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul and Hospital Moinhos de Vento, Porto Alegre, Brazil
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15
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Mariet AS, Giroud M, Benzenine E, Cottenet J, Roussot A, Aho-Glélé LS, Tubert-Bitter P, Béjot Y, Quantin C. Hospitalizations for Stroke in France During the COVID-19 Pandemic Before, During, and After the National Lockdown. Stroke 2021; 52:1362-1369. [PMID: 33626900 DOI: 10.1161/strokeaha.120.032312] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE In France, the entire population was put under a total lockdown from March 17 to May 11, 2020 during the peak of the coronavirus disease 2019 (COVID-19) pandemic. Whether the lockdown had consequences on the management of medical emergencies such as stroke and transient ischemic attack (TIA) has yet to be fully evaluated. This article describes hospitalization rates for acute stroke in 2 French regions that experienced contrasting rates of COVID-19 infection, before, during, and after the nationwide lockdown (January to June 2020). METHODS All patients admitted for acute stroke/TIA into all public and private hospitals of the 2 study regions were included. Data were retrieved from the National Hospitalization Database (PMSI). In the most affected region (Grand-Est), the hospitalization rates observed in April 2020 were compared with the rates in the same period in the least affected region (Occitanie) and in the 3 prior years (2017-2019). RESULTS There was a significant decline in hospitalization rates for stroke/TIA within the region most affected by COVID-19 during the month of April 2020 compared with previous years, while no significant change was seen in the least affected region. After lockdown, we observed a fast rebound in the rate of hospitalization for stroke/TIA in the most affected region, contrasting with a slower rebound in the least affected region. In both regions, patients with COVID-19 stroke more frequently had ischemic stroke, a nonsignificant greater prevalence of diabetes, they were less frequently admitted to stroke units, and mortality was higher than in patients without COVID-19. CONCLUSIONS Our results demonstrates a significant drop in stroke/TIA hospitalizations and a fast recovery after the end of the French lockdown in the most affected region, while the least affected region saw a nonsignificant drop in stroke/TIA hospitalizations and a slow recovery. These results and recommendations could be used by the health authorities to prepare for future challenges.
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Affiliation(s)
- Anne-Sophie Mariet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France (A.-S.M., E.B., J.C., A.R., C.Q.).,Inserm, CIC 1432, Dijon, France (A.-S.M., C.Q.).,Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/clinical trials unit, France (A.-S.M., C.Q.)
| | - Maurice Giroud
- Dijon Stroke Registry - EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy - UBFC (M.G., Y.B.), University Hospital of Dijon, Bourgogne, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France (A.-S.M., E.B., J.C., A.R., C.Q.)
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France (A.-S.M., E.B., J.C., A.R., C.Q.)
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France (A.-S.M., E.B., J.C., A.R., C.Q.)
| | - Ludwig Serge Aho-Glélé
- Department of Epidemiology and Hospital Hygiene (L.S.A.-G.), University Hospital of Dijon, Bourgogne, France
| | - Pascale Tubert-Bitter
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France (P.T.-B., C.Q.)
| | - Yannick Béjot
- Dijon Stroke Registry - EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy - UBFC (M.G., Y.B.), University Hospital of Dijon, Bourgogne, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France (A.-S.M., E.B., J.C., A.R., C.Q.).,Inserm, CIC 1432, Dijon, France (A.-S.M., C.Q.).,Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/clinical trials unit, France (A.-S.M., C.Q.).,Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France (P.T.-B., C.Q.)
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16
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Deliwala SS, Hussain M, Ponnapalli A, Awuah D, Dawood T, Bachuwa G. Acute confusional state as a prognostic sign of COVID-19 large-vessel occlusion (LVO). BMJ Case Rep 2021; 14:14/2/e240536. [PMID: 33622754 PMCID: PMC7907863 DOI: 10.1136/bcr-2020-240536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
COVID-19 is well known for its respiratory symptoms, but severe presentations can alter haemostasis, causing acute end-organ damage with poor outcomes. Among its various neurological presentations, cerebrovascular events often present as small-vessel strokes. Although uncommon, in predisposed individuals, large-vessel occlusions (LVOs) can occur as a possible consequence of direct viral action (viral burden or antigenic structure) or virus-induced cytokine storm. Subtle presentations and complicated stroke care pathways continue to exist, delaying timely care. We present a unique case of COVID-19 LVO manifesting as an acute confusional state in an elderly man in April 2020. CT angiography revealed 'de novo' occlusions of the left internal carotid artery and proximal right vertebral artery, effectively blocking anterior and posterior circulations. Delirium can lead to inaccurate stroke scale assessments and prolong initiation of COVID-19 stroke care pathways. Future studies are needed to look into the temporal relationship between confusion and neurological manifestations.
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Affiliation(s)
| | - Murtaza Hussain
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | | | - Dominic Awuah
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Thair Dawood
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Ghassan Bachuwa
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
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17
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Affiliation(s)
- Joseph P Broderick
- Department of Neurology, University of Cincinnati Gairdner Neuroscience Institute, University of Cincinnati Academic Health Center, OH (J.P.H.)
| | - Michael D Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary and Foothills Medical Centre, Alberta, Canada (M.D.H.)
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18
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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.
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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
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19
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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?
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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
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