Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Presentation, Treatment, and Outcomes

Introduction. The World Health Organization declared COVID-19 a global pandemic last year. While a clear impact of COVID-19 on the declining stroke volume has been reported, its overall impact on stroke presentation and clinical outcomes has not been established. The purpose of this study was to ass...

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Main Authors: Timothy G. White, Gabriela Martinez, Jason Wang, Michele Gribko, Artem Boltyenkov, Rohan Arora, Jeffrey M. Katz, Henry H. Woo, Pina C. Sanelli
Format: Article
Language:English
Published: Wiley 2021-01-01
Series:Stroke Research and Treatment
Online Access:http://dx.doi.org/10.1155/2021/8653396
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author Timothy G. White
Gabriela Martinez
Jason Wang
Michele Gribko
Artem Boltyenkov
Rohan Arora
Jeffrey M. Katz
Henry H. Woo
Pina C. Sanelli
author_facet Timothy G. White
Gabriela Martinez
Jason Wang
Michele Gribko
Artem Boltyenkov
Rohan Arora
Jeffrey M. Katz
Henry H. Woo
Pina C. Sanelli
author_sort Timothy G. White
collection DOAJ
description Introduction. The World Health Organization declared COVID-19 a global pandemic last year. While a clear impact of COVID-19 on the declining stroke volume has been reported, its overall impact on stroke presentation and clinical outcomes has not been established. The purpose of this study was to assess the impact of COVID-19 on acute ischemic stroke volume, presentation, treatment, and outcomes at comprehensive stroke centers. Methods. A retrospective review of patients with a discharge diagnosis of acute ischemic stroke from the Get With The Guidelines database was performed from January 1, 2019, to July 1, 2020. The following time periods were defined: Pre-COVID (January/February), Peak-COVID (March/April), and Post-COVID (May/June). Bivariate analyses were performed comparing the 2020 and 2019 time periods to determine differences in stroke volume, presentation, treatment, and outcomes. Results. Stroke volumes were significantly lower during the Peak-COVID period in 2020 compared to that in 2019, with an absolute decline of 49.5% (P<0.001). Patients were more likely to present after 24 hours from last known well during the 2020 Peak-COVID period (P=0.03). However, there was not a significant difference in the rate of treatment with either the tissue plasminogen activator (tPA) or mechanical thrombectomy during the Peak-COVID period. Interestingly, relative treatment rates increased during the 2020 Post-COVID period to 11.4% (P=0.01). Conclusions. The overall ischemic stroke volume decreased during the pandemic, and patients had a tendency to present later, beyond eligible treatment windows. However, rates of treatment, patient demographics, and stroke outcomes did not significantly change when compared to the prior year.
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spelling doaj-art-5928e1139e4e4c40a5fdeb9975ffabb42025-02-03T07:23:31ZengWileyStroke Research and Treatment2090-81052042-00562021-01-01202110.1155/2021/86533968653396Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Presentation, Treatment, and OutcomesTimothy G. White0Gabriela Martinez1Jason Wang2Michele Gribko3Artem Boltyenkov4Rohan Arora5Jeffrey M. Katz6Henry H. Woo7Pina C. Sanelli8Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USACenter of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY, USACenter of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY, USADepartment of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USACenter of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY, USADepartment of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USADepartment of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USADepartment of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USACenter of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY, USAIntroduction. The World Health Organization declared COVID-19 a global pandemic last year. While a clear impact of COVID-19 on the declining stroke volume has been reported, its overall impact on stroke presentation and clinical outcomes has not been established. The purpose of this study was to assess the impact of COVID-19 on acute ischemic stroke volume, presentation, treatment, and outcomes at comprehensive stroke centers. Methods. A retrospective review of patients with a discharge diagnosis of acute ischemic stroke from the Get With The Guidelines database was performed from January 1, 2019, to July 1, 2020. The following time periods were defined: Pre-COVID (January/February), Peak-COVID (March/April), and Post-COVID (May/June). Bivariate analyses were performed comparing the 2020 and 2019 time periods to determine differences in stroke volume, presentation, treatment, and outcomes. Results. Stroke volumes were significantly lower during the Peak-COVID period in 2020 compared to that in 2019, with an absolute decline of 49.5% (P<0.001). Patients were more likely to present after 24 hours from last known well during the 2020 Peak-COVID period (P=0.03). However, there was not a significant difference in the rate of treatment with either the tissue plasminogen activator (tPA) or mechanical thrombectomy during the Peak-COVID period. Interestingly, relative treatment rates increased during the 2020 Post-COVID period to 11.4% (P=0.01). Conclusions. The overall ischemic stroke volume decreased during the pandemic, and patients had a tendency to present later, beyond eligible treatment windows. However, rates of treatment, patient demographics, and stroke outcomes did not significantly change when compared to the prior year.http://dx.doi.org/10.1155/2021/8653396
spellingShingle Timothy G. White
Gabriela Martinez
Jason Wang
Michele Gribko
Artem Boltyenkov
Rohan Arora
Jeffrey M. Katz
Henry H. Woo
Pina C. Sanelli
Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Presentation, Treatment, and Outcomes
Stroke Research and Treatment
title Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Presentation, Treatment, and Outcomes
title_full Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Presentation, Treatment, and Outcomes
title_fullStr Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Presentation, Treatment, and Outcomes
title_full_unstemmed Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Presentation, Treatment, and Outcomes
title_short Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Presentation, Treatment, and Outcomes
title_sort impact of the covid 19 pandemic on acute ischemic stroke presentation treatment and outcomes
url http://dx.doi.org/10.1155/2021/8653396
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