Journal article
Delays in thrombolysis during COVID-19 are associated with worse neurological outcomes: the Society of Vascular and Interventional Neurology Multicenter Collaboration
Journal of neurology, Vol.269(2), pp.603-608
02/2022
DOI: 10.1007/s00415-021-10734-z
PMCID: PMC8325534
PMID: 34333701
Abstract
We have demonstrated in a multicenter cohort that the COVID-19 pandemic has led to a delay in intravenous thrombolysis (IVT) among stroke patients. Whether this delay contributes to meaningful short-term outcome differences in these patients warranted further exploration.
We conducted a nested observational cohort study of adult acute ischemic stroke patients receiving IVT from 9 comprehensive stroke centers across 7 U.S states. Patients admitted prior to the COVID-19 pandemic (1/1/2019-02/29/2020) were compared to patients admitted during the early pandemic (3/1/2020-7/31/2020). Multivariable logistic regression was used to estimate the effect of IVT delay on discharge to hospice or death, with treatment delay on admission during COVID-19 included as an interaction term.
Of the 676 thrombolysed patients, the median age was 70 (IQR 58-81) years, 313 were female (46.3%), and the median NIHSS was 8 (IQR 4-16). Longer treatment delays were observed during COVID-19 (median 46 vs 38 min, p = 0.01) and were associated with higher in-hospital death/hospice discharge irrespective of admission period (OR per hour 1.08, 95% CI 1.01-1.17, p = 0.03). This effect was strengthened after multivariable adjustment (aOR 1.15, 95% CI 1.07-1.24, p < 0.001). There was no interaction of treatment delay on admission during COVID-19 (p
= 0.65). Every one-hour delay in IVT was also associated with 7% lower odds of being discharged to home or acute inpatient rehabilitation facility (aOR 0.93, 95% CI 0.89-0.97, p < 0.001).
Treatment delays observed during the COVID-19 pandemic led to greater early mortality and hospice care, with a lower probability of discharge to home/rehabilitation facility. There was no effect modification of treatment delay on admission during the pandemic, indicating that treatment delay at any time contributes similarly to these short-term outcomes.
Details
- Title: Subtitle
- Delays in thrombolysis during COVID-19 are associated with worse neurological outcomes: the Society of Vascular and Interventional Neurology Multicenter Collaboration
- Creators
- Dinesh V Jillella - Emory UniversityFadi Nahab - Emory UniversityThanh N Nguyen - Boston Medical CenterMohamad Abdalkader - Boston Medical CenterDavid S Liebeskind - Ronald Reagan UCLA Medical CenterNirav Vora - Riverside Methodist HospitalVivek Rai - Riverside Methodist HospitalDiogo C Haussen - Grady Memorial HospitalRaul G Nogueira - Grady Memorial HospitalShashvat Desai - University of Pittsburgh Medical CenterAshutosh P Jadhav - University of Pittsburgh Medical CenterAlexandra L Czap - The University of Texas at AustinAlicia M Zha - The University of Texas at AustinItalo Linfante - Department of Interventional Neuroradiology and Endovascular Neurosurgery, Baptist Health South Florida, Coral Gables, FL, 33146, USA.Ameer E Hassan - Valley Baptist Medical CenterDarko Quispe-Orozco - University of IowaSantiago Ortega-Gutierrez - University of IowaPriyank Khandelwal - Robert Wood Johnson University HospitalPratit Patel - Robert Wood Johnson University HospitalOsama Zaidat - St Vincent Medical CenterTudor G Jovin - Cooper University HospitalScott Kamen - Cooper Medical School of Rowan UniversityJames E Siegler - Cooper University Hospital
- Resource Type
- Journal article
- Publication Details
- Journal of neurology, Vol.269(2), pp.603-608
- DOI
- 10.1007/s00415-021-10734-z
- PMID
- 34333701
- PMCID
- PMC8325534
- NLM abbreviation
- J Neurol
- ISSN
- 0340-5354
- eISSN
- 1432-1459
- Language
- English
- Date published
- 02/2022
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984303024602771
Metrics
13 Record Views