Journal Article

Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic

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

2021

Overview

•Multicenter study evaluating the impact of COVID-19 pandemic on ischemic stroke volumes, subtypes, and clinical presentation in US.•Significant decline was observed in the mean weekly volumes of newly diagnosed ischemic strokes, LVOs, and IV-tPA administration.•Patients admitted to the hospital had severe disease (NIHSS>14) and were more likely to discharge home. 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.

• Publisher: Elsevier B.V
• Subject: Coronavirus / COVID-19 / Ischemic stroke / Large vessel occlusion / Neurology / Neurosurgery / NIHSS