Impact of SARS-CoV-2 Pandemic on "Stroke Code" Imaging Utilization and Yield

Neuroimaging in acute ischemic stroke: Trends, disparities, and clinical impact

INTRODUCTION

Clinical studies over the past decade expanded the eligibility criteria for endovascular therapy, with advanced imaging selection and new devices leading to higher rates of good outcomes. Herein, we explore the current trends in neuroimaging, associated factors, and impact on treatment and clinical outcomes.

MATERIALS AND METHODS

This is a retrospective study of consecutive acute ischemic stroke patients, admitted to a comprehensive stroke center from 2016 to 2020. Patient characteristics, including age, sex, race, arrival method, admission National Institutes of Health Stroke Scale score and last known well to arrival time; imaging and treatment utilization; and discharge outcome by modified Rankin Scale and disposition were extracted from medical records. Trend and multivariable logistic regression analyses were performed, and trends were stratified by patient characteristics.

RESULTS

Of 4,125 acute ischemic stroke episodes, 15.1% received intravenous thrombolysis only, and 7.5% received endovascular thrombectomy from 2016 to 2020. Neuroimaging utilization trends significantly increased for computed tomography angiography (CTA) (48.7% to 75.2%, p < 0.001) and computed tomography perfusion (CTP) (0.26% to 32.9%, p < 0.001), and decreased for magnetic resonance angiography (MRA) (43.2% to 24.7%, p < 0.001). These trends held after adjusting for patient characteristics. Endovascular thrombectomy and intravenous thrombolysis were significantly more common in patients with CTA and CTP (p < 0.0001), and these treatments were associated with good clinical outcomes after controlling for patient characteristics.

CONCLUSION

We found significantly increased trends in CTA and CTP imaging, which were associated with endovascular thrombectomy and intravenous thrombolysis utilization, in acute ischemic stroke patients from 2016 to 2020.

Impact of COVID-19 on Hospital Admissions and Healthcare Quality Indicators in Non-COVID Patients: A Retrospective Study of the First COVID-19 Year in a University Hospital in Spain

Few studies have assessed the impact of the COVID-19 pandemic on non-COVID diseases and healthcare quality. We aimed to evaluate changes in rates of hospitalisations, complications, in-hospital mortality, and readmissions among patients with non-COVID diseases during a one-year period after the pandemic onset. From March 2018 to February 2021 a retrospective observational study of hospital admissions in a university hospital in Spain was conducted. Non-COVID hospitalisations admitted through the emergency department were compared between the pre-COVID period (n = 28,622) and the COVID period (n = 11,904). We assessed rate ratios (RaR), comparing the weekly number of admissions and risk ratios (RR) to examine rates of complications, in-hospital mortality, readmissions, and severity. Statistical significance was set at p < 0.05. The weekly admission rate dropped by 20.8% during the complete lockdown. We observed significant reductions in admissions related to diseases of the respiratory system and circulatory system. Admissions for endocrine and metabolic diseases increased. The complication rates increased (RR = 1.21, 95% CI: 1.05;1.4), while in-hospital mortality rates held steady during the COVID period (RR = 1.09, 95% CI: 0.98;1.2). Hospital efforts to maintain quality and safety standards despite disruptions translated into a moderate increase in complications but not in in-hospital mortality. Reduced hospitalisations for conditions requiring timely treatment may have significant public health consequences.