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Nawabi NLA, Duey AH, Kilgallon JL, Jessurun C, Doucette J, Mekary RA, Aziz-Sultan MA. Effects of the COVID-19 pandemic on stroke response times: a systematic review and meta-analysis. J Neurointerv Surg 2022; 14:642-649. [PMID: 35387860 DOI: 10.1136/neurintsurg-2021-018230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/24/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES COVID-19 presents a risk for delays to stroke treatment. We examined how COVID-19 affected stroke response times. METHODS A literature search was conducted to identify articles covering stroke during COVID-19 that included time metrics data pre- and post-pandemic. For each outcome, pooled relative change from baseline and 95% CI were calculated using random-effects models. Heterogeneity was explored through subgroup analyses comparing comprehensive stroke centers (CSCs) to non-CSCs. RESULTS 38 included studies reported on 6109 patients during COVID-19 and 14 637 patients during the pre-COVID period. Pooled increases of 20.9% (95% CI 5.8% to 36.1%) in last-known-well (LKW) to arrival times, 1.2% (-2.9% to 5.3%) in door-to-imaging (DTI), 0.8% (-2.9% to 4.5%) in door-to-needle (DTN), 2.8% (-5.0% to 10.6%) in door-to-groin (DTG), and 19.7% (11.1% to 28.2%) in door-to-reperfusion (DTR) times were observed during COVID-19. At CSCs, LKW increased by 24.0% (-0.3% to 48.2%), DTI increased by 1.6% (-3.0% to 6.1%), DTN increased by 3.6% (1.2% to 6.0%), DTG increased by 4.6% (-5.9% to 15.1%), and DTR increased by 21.2% (12.3% to 30.1%). At non-CSCs, LKW increased by 12.4% (-1.0% to 25.7%), DTI increased by 0.2% (-2.0% to 2.4%), DTN decreased by -4.6% (-11.9% to 2.7%), DTG decreased by -0.6% (-8.3% to 7.1%), and DTR increased by 0.5% (-31.0% to 32.0%). The increases during COVID-19 in LKW (p=0.01) and DTR (p=0.00) were statistically significant, as was the difference in DTN delays between CSCs and non-CSCs (p=0.04). CONCLUSIONS Factors during COVID-19 resulted in significantly delayed LKW and DTR, and mild delays in DTI, DTN, and DTG. CSCs experience more pronounced delays than non-CSCs.
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Affiliation(s)
- Noah L A Nawabi
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA .,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Akiro H Duey
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John L Kilgallon
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charissa Jessurun
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Joanne Doucette
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Library and Learning Resources, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pharmaceutical Business and Administrative Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Mohammad Ali Aziz-Sultan
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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2
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Stamm B, Huang D, Royan R, Lee J, Marquez J, Desai M. Pathomechanisms and Treatment Implications for Stroke in COVID-19: A Review of the Literature. Life (Basel) 2022; 12:life12020207. [PMID: 35207494 PMCID: PMC8877423 DOI: 10.3390/life12020207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
Abstract
Stroke in patients with COVID-19 has received increasing attention throughout the global COVID-19 pandemic, perhaps due to the substantial disability and mortality that can result when the two conditions co-occur. We reviewed the existing literature and found that the proposed pathomechanism underlying COVID-19-associated ischemic stroke is broadly divided into the following three categories: vasculitis, endothelialitis, and endothelial dysfunction; hypercoagulable state; and cardioembolism secondary to cardiac dysfunction. There has been substantial debate as to whether there is a causal link between stroke and COVID-19. However, the distinct phenotype of COVID-19-associated strokes, with multivessel territory infarcts, higher proportion of large vessel occlusions, and cryptogenic stroke mechanism, that emerged in pooled analytic comparisons with non-COVID-19 strokes is compelling. Further, in this article, we review the various treatment approaches that have emerged as they relate to the proposed pathomechanisms. Finally, we briefly cover the logistical challenges, such as delays in treatment, faced by providers and health systems; the innovative approaches utilized, including the role of tele-stroke; and the future directions in COVID-19-associated stroke research and healthcare delivery.
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Affiliation(s)
- Brian Stamm
- Department of Neurology, School of Medicine, Northwestern University Feinberg, Chicago, IL 60611, USA; (D.H.); (J.L.)
- Correspondence: (B.S.); or (M.D.)
| | - Deborah Huang
- Department of Neurology, School of Medicine, Northwestern University Feinberg, Chicago, IL 60611, USA; (D.H.); (J.L.)
| | - Regina Royan
- Department of Emergency Medicine, School of Medicine, Northwestern University Feinberg, Chicago, IL 60611, USA;
| | - Jessica Lee
- Department of Neurology, School of Medicine, Northwestern University Feinberg, Chicago, IL 60611, USA; (D.H.); (J.L.)
| | - Joshua Marquez
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM 87144, USA;
| | - Masoom Desai
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM 87144, USA;
- Correspondence: (B.S.); or (M.D.)
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3
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Benali F, Stolze LJ, Rozeman AD, Dinkelaar W, Coutinho JM, Emmer BJ, Gons RAR, Yo LFS, van Tuijl JH, Boukrab I, van Dam-Nolen DHK, van den Wijngaard IR, Lycklama À Nijeholt GJ, de Laat KF, van Dijk LC, den Hertog HM, Flach HZ, Wermer MJH, van Walderveen MAA, Brouwers PJAM, Bulut T, Vermeer SE, Bernsen MLE, Uyttenboogaart M, Bokkers RPH, Boogaarts JD, de Leeuw FE, van der Worp HB, van der Schaaf IC, Schonewille WJ, Vos JA, Remmers MJM, Imani F, Dippel DWJ, van Zwam WH, Nederkoorn PJ, van Oostenbrugge RJ. Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands. BMC Neurol 2022; 22:22. [PMID: 35016635 PMCID: PMC8749107 DOI: 10.1186/s12883-021-02539-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. METHODS We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. RESULTS A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. CONCLUSIONS During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.
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Affiliation(s)
- Faysal Benali
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Lotte J Stolze
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anouk D Rozeman
- Department of Neurology and Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Wouter Dinkelaar
- Department of Neurology and Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Jonathan M Coutinho
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Bart J Emmer
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Rob A R Gons
- Department of Neurology and Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Lonneke F S Yo
- Department of Neurology and Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Julia H van Tuijl
- Department of Neurology and Radiology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | - Issam Boukrab
- Department of Neurology and Radiology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | - Dianne H K van Dam-Nolen
- Department of Neurology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ido R van den Wijngaard
- Department of Neurology and Radiology, Haaglanden Medical Center, The Hague, the Netherlands
| | | | - Karlijn F de Laat
- Department of Neurology and Radiology, Haga Hospital, The Hague, the Netherlands
| | - Lukas C van Dijk
- Department of Neurology and Radiology, Haga Hospital, The Hague, the Netherlands
| | - Heleen M den Hertog
- Department of Neurology and Radiology, Isala Hospital, Zwolle, the Netherlands
| | - H Zwenneke Flach
- Department of Neurology and Radiology, Isala Hospital, Zwolle, the Netherlands
| | - Marieke J H Wermer
- Department of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Paul J A M Brouwers
- Department of Neurology and Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Tomas Bulut
- Department of Neurology and Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Sarah E Vermeer
- Department of Neurology and Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Maarten Uyttenboogaart
- Department of Neurology and Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Reinoud P H Bokkers
- Department of Neurology and Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jeroen D Boogaarts
- Department of Neurosurgery and Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurosurgery and Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Irene C van der Schaaf
- Department of Neurology and Neurosurgery and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wouter J Schonewille
- Department of Neurology and Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Jan A Vos
- Department of Neurology and Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Michel J M Remmers
- Department of Neurology and Radiology, Amphia Hospital, Breda, the Netherlands
| | - Farshad Imani
- Department of Neurology and Radiology, Amphia Hospital, Breda, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wim H van Zwam
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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4
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Katsanos AH, Palaiodimou L, Zand R, Yaghi S, Kamel H, Navi BB, Turc G, Benetou V, Sharma VK, Mavridis D, Shahjouei S, Catanese L, Shoamanesh A, Vadikolias K, Tsioufis K, Lagiou P, Sfikakis PP, Alexandrov AV, Tsiodras S, Tsivgoulis G. Changes in Stroke Hospital Care During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Stroke 2021; 52:3651-3660. [PMID: 34344166 PMCID: PMC8547579 DOI: 10.1161/strokeaha.121.034601] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE We systematically evaluated the impact of the coronavirus 2019 (COVID-19) pandemic on stroke care across the world. METHODS Observational studies comparing characteristics, acute treatment delivery, or hospitalization outcomes between patients with stroke admitted during the COVID-19 pandemic and those admitted before the pandemic were identified by Medline, Scopus, and Embase databases search. Random-effects meta-analyses were conducted for all outcomes. RESULTS We identified 46 studies including 129 491 patients. Patients admitted with stroke during the COVID-19 pandemic were found to be younger (mean difference, -1.19 [95% CI, -2.05 to -0.32]; I2=70%) and more frequently male (odds ratio, 1.11 [95% CI, 1.01-1.22]; I2=54%) compared with patients admitted with stroke in the prepandemic era. Patients admitted with stroke during the COVID-19 pandemic, also, had higher baseline National Institutes of Health Stroke Scale scores (mean difference, 0.55 [95% CI, 0.12-0.98]; I2=90%), higher probability for large vessel occlusion presence (odds ratio, 1.63 [95% CI, 1.07-2.48]; I2=49%) and higher risk for in-hospital mortality (odds ratio, 1.26 [95% CI, 1.05-1.52]; I2=55%). Patients with acute ischemic stroke admitted during the COVID-19 pandemic had higher probability of receiving endovascular thrombectomy treatment (odds ratio, 1.24 [95% CI, 1.05-1.47]; I2=40%). No difference in the rates of intravenous thrombolysis administration or difference in time metrics regarding onset to treatment time for intravenous thrombolysis and onset to groin puncture time for endovascular thrombectomy were detected. CONCLUSIONS The present systematic review and meta-analysis indicates an increased prevalence of younger patients, more severe strokes attributed to large vessel occlusion, and higher endovascular treatment rates during the COVID-19 pandemic. Patients admitted with stroke during the COVID-19 pandemic had higher in-hospital mortality. These findings need to be interpreted with caution in view of discrepant reports and heterogeneity being present across studies.
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Affiliation(s)
- Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., L.C., A.S.).,Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.H.K., L.P., G. Tsivgoulis.)
| | - Lina Palaiodimou
- Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.H.K., L.P., G. Tsivgoulis.)
| | - Ramin Zand
- Neurosience Institute, Geisinger Health System, Danville, Pennsylvania (R.Z., S.S.)
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health, NY (S.Y.)
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (H.K., B.B.N.)
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (H.K., B.B.N.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, France (G. Turc).,Université de Paris, France (G. Turc).,INSERM U1266, Paris, France (G. Turc).,FHU Neurovasc, Paris, France (G. Turc)
| | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece (V.B., P.L.)
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore and School of Medicine, National University of Singapore (V.K.S.)
| | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Greece (D.M.).,Université Paris Descartes, Faculté de Médecine, France (D.M.)
| | - Shima Shahjouei
- Neurosience Institute, Geisinger Health System, Danville, Pennsylvania (R.Z., S.S.)
| | - Luciana Catanese
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., L.C., A.S.)
| | - Ashkan Shoamanesh
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., L.C., A.S.)
| | - Konstantinos Vadikolias
- Department of Neurology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece (K.V.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Greece (K.T.)
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece (V.B., P.L.).,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.)
| | - Petros P Sfikakis
- Joint Rheumatology Program, First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece (P.P.S.)
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G. Tsivgoulis)
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.T.).,National Public Health Organization of Greece, Athens (S.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.H.K., L.P., G. Tsivgoulis.).,Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G. Tsivgoulis)
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5
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Srivastava PK, Zhang S, Xian Y, Xu H, Rutan C, Alger HM, Walchok JG, Williams JH, de Lemos JA, Decker-Palmer MR, Alhanti B, Elkind MSV, Messé SR, Smith EE, Schwamm LH, Fonarow GC. Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19: An Analysis From Get With The Guidelines-Stroke. Stroke 2021; 52:3225-3232. [PMID: 34192897 PMCID: PMC8478095 DOI: 10.1161/strokeaha.120.034414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. The coronavirus disease 2019 (COVID-19) pandemic has created challenges in the delivery of acute stroke care. In this study, we analyze the characteristics, evaluation, treatment, and in-hospital outcomes of patients presenting with acute ischemic stroke (AIS) pre-COVID-19 and during COVID-19.
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Affiliation(s)
- Pratyaksh K Srivastava
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA. (P.K.S., G.C.F.)
| | - Shuaiqi Zhang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. (S.Z., Y.X., B.A.)
| | - Ying Xian
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. (S.Z., Y.X., B.A.).,Department of Neurology, Duke University Medical Center, Durham, NC. (Y.X.)
| | - Hanzhang Xu
- Department of Family Medicine and Community Health (H.X.)
| | - Christine Rutan
- American Heart Association, Dallas, TX (C.R., H.M.A., J.G.W., J.H.W.)
| | - Heather M Alger
- American Heart Association, Dallas, TX (C.R., H.M.A., J.G.W., J.H.W.)
| | - Jason G Walchok
- American Heart Association, Dallas, TX (C.R., H.M.A., J.G.W., J.H.W.)
| | - Joseph H Williams
- American Heart Association, Dallas, TX (C.R., H.M.A., J.G.W., J.H.W.)
| | - James A de Lemos
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (J.A.d.L.)
| | | | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. (S.Z., Y.X., B.A.)
| | - Mitchell S V Elkind
- Department of Neurology and Department of Epidemiology, Columbia University, NY (M.S.V.E.)
| | - Steve R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.)
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.)
| | - Lee H Schwamm
- Department of Neurology, Comprehensive Stroke Center, Massachusetts General Hospital, Boston (L.H.S.)
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA. (P.K.S., G.C.F.).,Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA. (G.C.F.)
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6
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Triki CC, Leonardi M, Mallouli SZ, Cacciatore M, Karlshoej KC, Magnani FG, Newton CR, Pilotto A, Saylor D, Westenberg E, Walsh D, Winkler AS, Thakur KT, Okubadejo NU, Garcia-Azorin D. Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations. J Neurol 2021; 269:26-38. [PMID: 34117527 PMCID: PMC8195244 DOI: 10.1007/s00415-021-10641-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic outbreak has dramatically disrupted healthcare systems. Two rapid WHO pulse surveys studied disruptions in mental health services, but did not particularly focus on neurology. Here, a global survey was conducted and addresses the impact of the pandemic on neurology services. METHODS A cross-sectional study was carried out in which 34 international neurological associations were asked to distribute the survey to national associations. The responses represented the national situation, in November-December 2020, with regard to the main disrupted neurological services, reasons and the mitigation strategies implemented as well as the disruption on training of residents and on neurological research. A comparison with the situation in February-April 2020, first pandemic wave, was also requested. FINDINGS 54 completed surveys came from 43 countries covering all the 6 WHO regions. Overall, neurological services disruption was reported as mild by 26%, moderate by 30%, complete by 13% of associations. The most affected services were cross-sectoral neurological services (57%) and neurorehabilitation (56%). The second wave of the pandemic, however, was associated with the improvement of service provision for diagnostics services (44%) and for neurorehabilitation (41%). Governmental directives were the major cause of services' disruption (56%). Mitigation strategies were mostly established through telemedicine (48%). Almost half of respondents reported a significant impact on neurological research (48%) and educational activities (60%). Most associations (67%) were not involved in decision making for neurological patients' issues by their national government. INTERPRETATION The COVID-19 pandemic affects neurological services and raises the universal need for the development of neurological health care at the policy, systems and services levels. A global national plan on mitigation strategies for disruption of neurological services during pandemic situations should be established and neurological scientific and patients associations should get involved in decision making.
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Affiliation(s)
- Chahnez Charfi Triki
- Child Neurology Department, Hédi Chaker Hospital, LR19ES15, Sfax University, Sfax, Tunisia
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Salma Zouari Mallouli
- Child Neurology Department, Hédi Chaker Hospital, LR19ES15, Sfax University, Sfax, Tunisia
| | - Martina Cacciatore
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Kimberly Coard Karlshoej
- World Federation of Neurology, Cqhester House, Fulham Green, 81-83 Fulham High Street, London, SW6 3JA, UK
| | - Francesca Giulia Magnani
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erica Westenberg
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Donna Walsh
- European Federation of Neurological Associations, Brussels, Belgium
| | - Andrea Sylvia Winkler
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kiran T Thakur
- Department of Neurology, Columbia-Irving University Medical Center/New York Presbyterian Hospital, New York, USA
| | - Njideka U Okubadejo
- Neurology Unit, Department of Neurology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - David Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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7
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Alterations in the Cranial CT Rates: Comparison of the COVID-19 Lockdown and non-COVID 19 era. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2021. [DOI: 10.21673/anadoluklin.909018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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8
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Huo X, Sun X, Mo D, Gao F, Ma N, Wang Y, Wang Y, Miao Z. Influence of coronavirus disease 2019 (COVID-19) on working flow, safety and efficacy outcome of mechanical thrombectomy for acute ischemic stroke with large vessel occlusion. Interv Neuroradiol 2021; 28:58-64. [PMID: 34000867 PMCID: PMC8902314 DOI: 10.1177/15910199211018093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim The epidemic of COVID-19 has greatly affect the world health care system, particular measures have been taken not only to provide safety for health care providers but also to maintain the treatment quality. We evaluate the effect of COVID-19 epidemic to acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) received endovascular treatment (EVT) in our institution. Methods AIS patients with LVO who underwent EVT in the period of January 1st to April 30th between 2015 and 2020 from our stroke center. The baseline characteristics, working flow time, safety and efficacy outcome and the hospitalization status were retrospectively reviewed, compared and analyzed. Results There is significant decline in the number of AIS patients with LVO treated compared with the previous year (36 Vs 72 patients) during the epidemic period. The door to puncture time was significantly prolong (225 minutes versus 115 minutes) as well as the length of hospital stay with increase of the hospitalization costs (P < 0.05 for all). There is no significant difference on the safety and efficacy outcome, such recanalization rate, incidence of intracranial hemorrhage, functional independence and mortality during the epidemic (P > 0.05 for all). Conclusions Prolongation of the working time flow during the COVID-19 epidemic did not influence the safety and efficacy of EVT in AIS patients with LVO. However, special policy and particular measures in this circumstances is still need to evolve to improve the treatment quality.
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Affiliation(s)
- Xiaochuan Huo
- NeuroIntervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuan Sun
- NeuroIntervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- NeuroIntervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- NeuroIntervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- NeuroIntervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhongrong Miao
- NeuroIntervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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