Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: The Society of Vascular and Interventional Neurology Multicenter Collaboration

Santiago Ortega-Gutierrez; Mudassir Farooqui; Alicia Zha; Alexandra Czap; Jacob Sebaugh; Shashvat Desai; Ashutosh Jadhav; Nirav Vora; Vivek Rai; Tudor G Jovin; Jesse M Thon; Mark Heslin; Lauren Thau; Cynthia Zevallos; Darko Quispe-Orozco; Dinesh V Jillella; Fadi Nahab; Mahmoud H Mohammaden; Raul G Nogueira; Diogo C Haussen; Thanh N Nguyen; Jose Rafael Romero; Hugo J Aparicio; Mohamed Osman; Israr Ul Haq; David Liebeskind; Ameer E Hassan; Osama Zaidat; James E Siegler; SVIN COVID-19 Multinational Registry and Task Force

doi:10.1016/j.clineuro.2020.106436

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Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: The Society of Vascular and Interventional Neurology Multicenter Collaboration

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Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: The Society of Vascular and Interventional Neurology Multicenter Collaboration

Santiago Ortega-Gutierrez, Mudassir Farooqui, Alicia Zha, Alexandra Czap, Jacob Sebaugh, Shashvat Desai, Ashutosh Jadhav, Nirav Vora, Vivek Rai, Tudor G Jovin, …

Clinical neurology and neurosurgery, Vol.201, pp.106436-106436

02/2021

DOI: 10.1016/j.clineuro.2020.106436

PMCID: PMC7836428

PMID: 33383463

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Abstract

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. 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. 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). 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.

Administration, Intravenous

Adult

Aged

Aged, 80 and over

Cohort Studies

COVID-19 - diagnosis

COVID-19 - epidemiology

Female

Humans

Male

Middle Aged

Neurology - trends

Pandemics

Retrospective Studies

Societies, Medical - trends

Stroke - diagnosis

Stroke - drug therapy

Stroke - epidemiology

Thrombolytic Therapy - trends

Tissue Plasminogen Activator - administration & dosage

United States - epidemiology

Vascular Diseases - drug therapy

Vascular Diseases - epidemiology

Details

Title: Subtitle: Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: The Society of Vascular and Interventional Neurology Multicenter Collaboration
Creators: Santiago Ortega-Gutierrez - University of Iowa Hospitals and Clinics
Mudassir Farooqui - University of Iowa
Alicia Zha - Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030, USA.
Alexandra Czap - Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030, USA.
Jacob Sebaugh - Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030, USA.
Shashvat Desai - University of Pittsburgh Medical Center
Ashutosh Jadhav - University of Pittsburgh Medical Center
Nirav Vora - Riverside Methodist Hospital
Vivek Rai - Riverside Methodist Hospital
Tudor G Jovin - Cooper University Hospital
Jesse M Thon - Cooper University Hospital
Mark Heslin - Cooper University Hospital
Lauren Thau - University of Iowa Hospitals and Clinics
Cynthia Zevallos - University of Iowa
Darko Quispe-Orozco - University of Iowa
Dinesh V Jillella - Grady Memorial Hospital
Fadi Nahab - Emory University
Mahmoud H Mohammaden - Grady Memorial Hospital
Raul G Nogueira - Grady Memorial Hospital
Diogo C Haussen - Grady Memorial Hospital
Thanh N Nguyen - Boston Medical Center
Jose Rafael Romero - Boston Medical Center
Hugo J Aparicio - Boston Medical Center
Mohamed Osman - Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH, 43608, USA.
Israr Ul Haq - Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH, 43608, USA.
David Liebeskind - Ronald Reagan UCLA Medical Center
Ameer E Hassan - Valley Baptist Medical Center
Osama Zaidat - St Vincent Medical Center
James E Siegler - Cooper University Hospital
SVIN COVID-19 Multinational Registry and Task Force
Resource Type: Journal article
Publication Details: Clinical neurology and neurosurgery, Vol.201, pp.106436-106436
DOI: 10.1016/j.clineuro.2020.106436
PMID: 33383463
PMCID: PMC7836428
NLM abbreviation: Clin Neurol Neurosurg
ISSN: 0303-8467
eISSN: 1872-6968
Language: English
Date published: 02/2021
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984303012702771

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