Global Impact of COVID-19 on Stroke Care and IV Thrombolysis.
Journal: Neurology
Published:
Abstract
Objective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.
Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.
Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions.
Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.
Authors
Raul Nogueira, Muhammad Qureshi, Mohamad Abdalkader, Sheila Martins, Hiroshi Yamagami, Zhongming Qiu, Ossama Mansour, Anvitha Sathya, Anna Czlonkowska, Georgios Tsivgoulis, Diana Aguiar De Sousa, Jelle Demeestere, Robert Mikulik, Peter Vanacker, James Siegler, Janika Kõrv, Jose Biller, Conrad Liang, Navdeep Sangha, Alicia Zha, Alexandra Czap, Christine Holmstedt, Tanya Turan, George Ntaios, Konark Malhotra, Ashis Tayal, Aaron Loochtan, Annamarei Ranta, Eva Mistry, Anne Alexandrov, David Huang, Shadi Yaghi, Eytan Raz, Sunil Sheth, Mahmoud Mohammaden, Michael Frankel, Eric Bila Lamou, Hany Aref, Ahmed Elbassiouny, Farouk Hassan, Tarek Menecie, Wessam Mustafa, Hossam Shokri, Tamer Roushdy, Fred Sarfo, Tolulope Alabi, Babawale Arabambi, Ernest Nwazor, Taofiki Sunmonu, Kolawole Wahab, Joseph Yaria, Haytham Mohammed, Philip Adebayo, Anis Riahi, Samia Sassi, Lenon Gwaunza, Gift Ngwende, David Sahakyan, Aminur Rahman, Zhibing Ai, Fanghui Bai, Zhenhui Duan, Yonggang Hao, Wenguo Huang, Guangwen Li, Wei Li, Ganzhe Liu, Jun Luo, Xianjin Shang, Yi Sui, Ling Tian, Hongbin Wen, Bo Wu, Yuying Yan, Zhengzhou Yuan, Hao Zhang, Jun Zhang, Wenlong Zhao, Wenjie Zi, Thomas Leung, Chandril Chugh, Vikram Huded, Bindu Menon, Jeyaraj Pandian, P Sylaja, Fritz Usman, Mehdi Farhoudi, Elyar Hokmabadi, Anat Horev, Anna Reznik, Rotem Sivan Hoffmann, Nobuyuki Ohara, Nobuyuki Sakai, Daisuke Watanabe, Ryoo Yamamoto, Ryosuke Doijiri, Naoki Tokuda, Takehiro Yamada, Tadashi Terasaki, Yukako Yazawa, Takeshi Uwatoko, Tomohisa Dembo, Hisao Shimizu, Yuri Sugiura, Fumio Miyashita, Hiroki Fukuda, Kosuke Miyake, Junsuke Shimbo, Yusuke Sugimura, Yoshiki Yagita, Yohei Takenobu, Yuji Matsumaru, Satoshi Yamada, Ryuhei Kono, Takuya Kanamaru, Hidekazu Yamazaki, Manabu Sakaguchi, Kenichi Todo, Nobuaki Yamamoto, Kazutaka Sonoda, Tomoko Yoshida, Hiroyuki Hashimoto, Ichiro Nakahara, Aida Kondybayeva, Kamila Faizullina, Saltanat Kamenova, Murat Zhanuzakov, Jang-hyun Baek, Yangha Hwang, Jin Lee, Si Lee, Jusun Moon, Hyungjong Park, Jung Seo, Kwon-duk Seo, Sung Sohn, Chang Young, Rechdi Ahdab, Wan Wan Zaidi, Zariah Aziz, Hamidon Basri, Law Chung, Aznita Ibrahim, Khairul Ibrahim, Irene Looi, Wee Tan, Nafisah Yahya, Stanislav Groppa, Pavel Leahu, Amal Al Hashmi, Yahia Imam, Naveed Akhtar, Maria Pineda Franks, Christian Co, Dmitriy Kandyba, Adel Alhazzani, Hosam Al Jehani, Carol Tham, Marlie Mamauag, Narayanaswamy Venketasubramanian, Chih-hao Chen, Sung-chun Tang, Anchalee Churojana, Esref Akil, Özlem Aykaç, Atilla Ozdemir, Semih Giray, Syed Hussain, Seby John, Huynh Le Vu, Anh Tran, Huy Nguyen, Thong Nhu Pham, Thang Nguyen, Trung Nguyen, Thomas Gattringer, Christian Enzinger, Monika Killer Oberpfalzer, Flavio Bellante, Sofie De Blauwe, Geert Vanhooren, Sylvie De Raedt, Anne Dusart, Robin Lemmens, Noemie Ligot, Matthieu Pierre Rutgers, Laetitia Yperzeele, Filip Alexiev, Teodora Sakelarova, Marina Bedeković, Hrvoje Budincevic, Igor Cindric, Zlatko Hucika, David Ozretic, Majda Saric, František Pfeifer, Igor Karpowic, David Cernik, Martin Sramek, Miroslav Skoda, Helena Hlavacova, Lukas Klecka, Martin Koutny, Daniel Vaclavik, Ondrej Skoda, Jan Fiksa, Katerina Hanelova, Miroslava Nevsimalova, Robert Rezek, Petr Prochazka, Gabriela Krejstova, Jiri Neumann, Marta Vachova, Henryk Brzezanski, David Hlinovsky, Dusan Tenora, Rene Jura, Lubomír Jurák, Jan Novak, Ales Novak, Zdenek Topinka, Petr Fibrich, Helena Sobolova, Ondrej Volny, Hanne Krarup Christensen, Nicolas Drenck, Helle Klingenberg Iversen, Claus Simonsen, Thomas Truelsen, Troels Wienecke, Riina Vibo, Katrin Gross Paju, Toomas Toomsoo, Katrin Antsov, Francois Caparros, Charlotte Cordonnier, Maria Dan, Jean-marc Faucheux, Laura Mechtouff, Omer Eker, Emilie Lesaine, Basile Ondze, Roxane Peres, Fernando Pico, Michel Piotin, Raoul Pop, Francois Rouanet, Tatuli Gubeladze, Mirza Khinikadze, Nino Lobjanidze, Alexander Tsiskaridze, Simon Nagel, Peter Ringleb, Michael Rosenkranz, Holger Schmidt, Annahita Sedghi, Timo Siepmann, Kristina Szabo, Götz Thomalla, Lina Palaiodimou, Dimitrios Sagris, Odysseas Kargiotis, Peter Klivenyi, Laszlo Szapary, Gabor Tarkanyi, Alessandro Adami, Fabio Bandini, Paolo Calabresi, Giovanni Frisullo, Leonardo Renieri, Davide Sangalli, Anne Pirson, Maarten Uyttenboogaart, Ido Van Den Wijngaard, Espen Kristoffersen, Waldemar Brola, Małgorzata Fudala, Ewa Horoch Lyszczarek, Michal Karlinski, Radoslaw Kazmierski, Pawel Kram, Marcin Rogoziewicz, Rafal Kaczorowski, Piotr Luchowski, Halina Sienkiewicz Jarosz, Piotr Sobolewski, Waldemar Fryze, Anna Wisniewska, Malgorzata Wiszniewska, Patricia Ferreira, Paulo Ferreira, Luisa Fonseca, João Marto, Teresa Pinho E Melo, Ana Nunes, Miguel Rodrigues, Vítor Tedim Cruz, Cristian Falup Pecurariu, Georgi Krastev, Miroslav Mako, María De Leciñana, Juan Arenillas, Oscar Ayo Martin, Antonio Cruz Culebras, Exuperio Tejedor, Joan Montaner, Soledad Pérez Sánchez, Miguel Tola Arribas, Alejandro Rodriguez Vasquez, Michael Mayza, Gianmarco Bernava, Alex Brehm, Paolo 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