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Nogueira RG, Abdalkader M, Qureshi MM, Frankel MR, Mansour OY, Yamagami H, Qiu Z, Farhoudi M, Siegler JE, Yaghi S, Raz E, Sakai N, Ohara N, Piotin M, Mechtouff L, Eker O, Chalumeau V, Kleinig TJ, Pop R, Liu J, Winters HS, Shang X, Vasquez AR, Blasco J, Arenillas JF, Martinez-Galdamez M, Brehm A, Psychogios MN, Lylyk P, Haussen DC, Al-Bayati AR, Mohammaden MH, Fonseca L, Luís Silva M, Montalverne F, Renieri L, Mangiafico S, Fischer U, Gralla J, Frei D, Chugh C, Mehta BP, Nagel S, Mohlenbruch M, Ortega-Gutierrez S, Farooqui M, Hassan AE, Taylor A, Lapergue B, Consoli A, Campbell BC, Sharma M, Walker M, Van Horn N, Fiehler J, Nguyen HT, Nguyen QT, Watanabe D, Zhang H, Le HV, Nguyen VQ, Shah R, Devlin T, Khandelwal P, Linfante I, Izzath W, Lavados PM, Olavarría VV, Sampaio Silva G, de Carvalho Sousa AV, Kirmani J, Bendszus M, Amano T, Yamamoto R, Doijiri R, Tokuda N, Yamada T, Terasaki T, Yazawa Y, Morris JG, Griffin E, Thornton J, Lavoie P, Matouk C, Hill MD, Demchuk AM, Killer-Oberpfalzer M, Nahab F, Altschul D, Ramos-Pachón A, Pérez de la Ossa N, Kikano R, Boisseau W, Walker G, Cordina SM, Puri A, Luisa Kuhn A, Gandhi D, Ramakrishnan P, Novakovic-White R, Chebl A, Kargiotis O, Czap A, Zha A, Masoud HE, Lopez C, Ozretic D, Al-Mufti F, Zie W, Duan Z, Yuan Z, Huang W, Hao Y, Luo J, Kalousek V, Bourcier R, Guile R, Hetts S, Al-Jehani HM, AlHazzani A, Sadeghi-Hokmabadi E, Teleb M, Payne J, Lee JS, Hong JM, Sohn SI, Hwang YH, Shin DH, Roh HG, Edgell R, Khatri R, Smith A, Malik A, Liebeskind D, Herial N, Jabbour P, Magalhaes P, Ozdemir AO, Aykac O, Uwatoko T, Dembo T, Shimizu H, Sugiura Y, Miyashita F, Fukuda H, Miyake K, Shimbo J, Sugimura Y, Beer-Furlan A, Joshi K, Catanese L, Abud DG, Neto OG, Mehrpour M, Al Hashmi A, Saqqur M, Mostafa A, Fifi JT, Hussain S, John S, Gupta R, Sivan-Hoffmann R, Reznik A, Sani AF, Geyik S, Akıl E, Churojana A, Ghoreishi A, Saadatnia M, Sharifipour E, Ma A, Faulder K, Wu T, Leung L, Malek A, Voetsch B, Wakhloo A, Rivera R, Barrientos Iman DM, Pikula A, Lioutas VA, Thomalla G, Birnbaum L, Machi P, Bernava G, McDermott M, Kleindorfer D, Wong K, Patterson MS, Fiorot JA, Huded V, Mack W, Tenser M, Eskey C, Multani S, Kelly M, Janardhan V, Cornett O, Singh V, Murayama Y, Mokin M, Yang P, Zhang X, Yin C, Han H, Peng Y, Chen W, Crosa R, Frudit ME, Pandian JD, Kulkarni A, Yagita Y, Takenobu Y, Matsumaru Y, Yamada S, Kono R, Kanamaru T, Yamazaki H, Sakaguchi M, Todo K, Yamamoto N, Sonoda K, Yoshida T, Hashimoto H, Nakahara I, Cora E, Volders D, Ducroux C, Shoamanesh A, Ospel J, Kaliaev A, Ahmed S, Rashid U, Rebello LC, Pereira VM, Fahed R, Chen M, Sheth SA, Palaiodimou L, Tsivgoulis G, Chandra R, Koyfman F, Leung T, Khosravani H, Dharmadhikari S, Frisullo G, Calabresi P, Tsiskaridze A, Lobjanidze N, Grigoryan M, Czlonkowska A, de Sousa DA, Demeestere J, Liang C, Sangha N, Lutsep HL, Ayo-Martín Ó, Cruz-Culebras A, Tran AD, Young CY, Cordonnier C, Caparros F, De Lecinana MA, Fuentes B, Yavagal D, Jovin T, Spelle L, Moret J, Khatri P, Zaidat O, Raymond J, Martins S, Nguyen T. Global impact of COVID-19 on stroke care. Int J Stroke 2021; 16:573-584. [PMID: 33459583 PMCID: PMC8010375 DOI: 10.1177/1747493021991652] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. Aims We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March–31 May 2020) compared with two control three-month periods (immediately preceding and one year prior). Methods Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. Results The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, −19.7 to −18.7), 11.5% (95%CI, −12.6 to −10.6), and 12.7% (95%CI, −13.6 to −11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (−20.5%) had greater declines in mechanical thrombectomy volumes than mid- (−10.1%) and low-volume (−8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. Conclusion The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes.
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Affiliation(s)
- Raul G Nogueira
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | - Mohamad Abdalkader
- Radiology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Muhammed M Qureshi
- Radiology, Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Michael R Frankel
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | - Ossama Yassin Mansour
- Neurology Department, Stroke and Neurointervention Division, Alexandria University Hospital, Alexandria University, Egypt
| | - Hiroshi Yamagami
- Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan
| | - Zhongming Qiu
- Neurology, Xinqiao Hospital of the Army Medical University, Chongqing, China
| | | | - James E Siegler
- Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Shadi Yaghi
- Neurology, Radiology, New York University School of Medicine, New York, USA
| | - Eytan Raz
- Radiology, Neurology, New York University School of Medicine, New York, USA
| | - Nobuyuki Sakai
- Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Ohara
- Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Michel Piotin
- Fondation Ophtalmologique Adolphe de Rothschild, France
| | | | - Omer Eker
- Neuroradiologie, Hospices Civils de Lyon, France
| | | | | | - Raoul Pop
- Hôpitaux Universitaires de Strasbourg, France
| | | | | | | | | | - Jordi Blasco
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Spain
| | | | | | | | | | - Pedro Lylyk
- Clínica Sagrada Familia, Buenos Aires, Argentina
| | - Diogo C Haussen
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | | | | | - Luísa Fonseca
- Stroke, Centro Hospitalar Universitário de São João, Portugal
| | - M Luís Silva
- Neuroradiology, Centro Hospitalar Universitário de São João, Portugal
| | | | | | | | - Urs Fischer
- Neurology, University Hospital Bern, Switzerland
| | - Jan Gralla
- Interventional Neuroradiology, University Hospital Bern, Switzerland
| | | | | | | | - Simon Nagel
- Neurology, University Hospital Heidelberg, Germany
| | | | | | | | - Ameer E Hassan
- Neurosciences, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Allan Taylor
- Neurosurgery, University of Cape Town, South Africa
| | | | | | | | | | | | - Noel Van Horn
- Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Jens Fiehler
- Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | | | | | - Hao Zhang
- Affiliated Hangzhou First People's Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Naoki Tokuda
- Japanese Red Cross Kyoto Daiichi Hospital, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - Fadi Nahab
- Emory University School of Medicine, USA
| | | | | | | | | | | | | | | | - Ajit Puri
- University of Massachusetts Medical Center, USA
| | | | | | | | | | | | | | | | - Alicia Zha
- UTHealth McGovern Medical School, Houston, USA
| | | | | | | | | | - Wenjie Zie
- Xinqiao Hospital of the Army Medical University, China
| | | | - Zhengzhou Yuan
- Affiliated Hospital of Southwest Medical University, China
| | - Wenguo Huang
- Maoming Traditional Chinese Medicine Hospital, China
| | | | - Jun Luo
- Mianyang 404 Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alice Ma
- Royal North Shore Hospital, Australia
| | | | - Teddy Wu
- Christchurch Hospital, Christchurch , New Zealand
| | | | | | | | - Ajay Wakhloo
- Interventional Neuroradiology, Beth Israel Lahey Health, USA
| | - Rodrigo Rivera
- Neuroradiology, Instituto de Neurocirugia Dr. Asengo, Chile
| | | | | | | | - Gotz Thomalla
- Neurology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | | | | | | | | | - Ken Wong
- Royal London Hospital, United Kingdom
| | | | | | | | | | | | - Clifford Eskey
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | | | | | | | | | | | | | | | | | - Congguo Yin
- Affiliated Hangzhou First People's Hospital, China
| | | | - Ya Peng
- First People's Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kenichi Todo
- Osaka University Graduate School of Medicine, Japan
| | - Nobuaki Yamamoto
- Tokushima University Graduate School of Biomedical Sciences, Japan
| | | | | | | | | | - Elena Cora
- Dalhousie University, Nova Scotia, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Conrad Liang
- Neurointerventional Radiology, Kaiser Permanente, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thanh Nguyen
- Radiology, Neurology, Boston Medical Center, USA
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