Faculty Collaboration Database

Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: The Society of Vascular and Interventional Neurology Multicenter Collaboration. Clin Neurol Neurosurg 2021 Feb;201:106436

Date

01/01/2021

Pubmed ID

33383463

Pubmed Central ID

PMC7836428

DOI

10.1016/j.clineuro.2020.106436

Scopus ID

2-s2.0-85098572095 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

BACKGROUND: To evaluate overall ischemic stroke volumes and rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US.

METHODS: We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as; March-May 2020 (COVID-19 period) and March-May 2019 (seasonal pre-COVID-19 period). Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0-7), moderate [8-14], and severe (>14). Secondary outcomes were volume of large vessel occlusions (LVOs), stroke etiology, IV-tPA rates, and discharge disposition.

RESULTS: Of the 7969 patients diagnosed with acute ischemic stroke during the study period, 933 (12 %) presented in the COVID-19 period while 1319 (17 %) presented in the seasonal pre-COVID-19 period. Significant decline was observed in the mean weekly volumes of newly diagnosed ischemic strokes (98 ± 3 vs 50 ± 20,p = 0.003), LVOs (16.5 ± 3.8 vs 8.3 ± 5.9,p = 0.008), and IV-tPA (10.9 ± 3.4 vs 5.3 ± 2.9,p = 0.0047), whereas the mean weekly proportion of LVOs (18 % ±5 vs 16 % ±7,p = 0.24) and IV-tPA (10.4 % ±4.5 vs. 9.9 % ±2.4,p = 0.66) remained the same, when compared to the seasonal pre-COVID-19 period. Additionally, an increased proportion of patients presented with a severe disease (NIHSS > 14) during the COVID-19 period (29.7 % vs 24.5 %,p < 0.025). The odds of being discharged to home were 26 % greater in the COVID-19 period when compared to seasonal pre-COVID-19 period (OR:1.26, 95 % CI:1.07-1.49,p = 0.016).

CONCLUSIONS: During COVID-19 period there was a decrease in volume of newly diagnosed ischemic stroke cases and IV-tPA administration. Patients admitted to the hospital had severe neurological clinical presentation and were more likely to discharge home.

Author List

Ortega-Gutierrez S, Farooqui M, Zha A, Czap A, Sebaugh J, Desai S, Jadhav A, Vora N, Rai V, Jovin TG, Thon JM, Heslin M, Thau L, Zevallos C, Quispe-Orozco D, Jillella DV, Nahab F, Mohammaden MH, Nogueira RG, Haussen DC, Nguyen TN, Romero JR, Aparicio HJ, Osman M, Haq IU, Liebeskind D, Hassan AE, Zaidat O, Siegler JE, SVIN COVID-19 Multinational Registry and Task Force

Author

Mohamed Osman MD Assistant Professor in the Neurology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Administration, Intravenous
Adult
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Male
Middle Aged
Neurology
Pandemics
Retrospective Studies
Societies, Medical
Stroke
Thrombolytic Therapy
Tissue Plasminogen Activator
United States
Vascular Diseases