Acute Stroke Care in the Coronavirus Disease 2019 Pandemic

Dafer, Rima M.; Osteraas, Nicholas; Biller, José

doi:10.1016/j.jstrokecerebrovasdis.2020.104881

Cited by 96 publications

(116 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, given that stroke thrombectomies must be done emergently due to the time-sensitive nature of cerebral ischemia, patients should be assumed to be COVID-19 positive and only essential personnel should be present in the angiography suite [ 13 ]. Others have recommended consolidating imaging studies to minimize staff exposure [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of the COVID-19 Pandemic on Stroke Patients

Ghanchi¹,

Takayanagi²,

Savla³

et al. 2020

Cureus

View full text Add to dashboard Cite

Introduction The severe acute respiratory syndrome coronavirus 2 (SARS2-CoV-2) induced pandemic (COVID-19 pandemic) has affected healthcare in all aspects, including stroke care. We sought to investigate this effect with analysis of our hospital’s stroke treatment protocols as well as stroke volume on state, regional, and national levels. Methods This was a retrospective review of prospectively collected data from our stroke registry to assess the impact of the SARS2-CoV-2 induced pandemic on the volume of stroke patients presenting to our facility. Demographics collected included age, sex, race, National Institute of Health Stroke Scale (NIHSS) on admission, discharge modified Rankin Score (mRS), type of stroke (ischemic, hemorrhagic, or transient ischemic attack), time of symptom onset, and time to initial imaging. Data were also stratified by date and comparison was made between the intra-COVID-period (March and April 2020), pre-COVID period (March and April 2019), and peri-COVID period (January and February 2020). To determine stroke trends on a national level, we utilized the Get with the Guidelines (GWTG) stroke database to compare stroke volumes in the pre-COVID, peri-COVID, and intra-COVID periods between our hospital, all California hospitals, and the West and Pacific regions. Results There was a significant increase in last known well time (LKWT) to arrival to the emergency department (ED) (LKWT to door) as well as time from arrival to the ED to obtaining a computed tomography (CT) of the head (door to CT) in March 2020 compared to 2019 (p=0.0220 and p=0.0475, respectively). There were significantly fewer transient ischemic attacks (TIAs) in California hospitals as well as in March and April 2020 in comparison to January and February 2020 (p=0.0417). Similarly, there were significantly fewer TIAs in March and April 2019 compared to March and April 2020 (p=0.0360). The decrease in TIAs was also seen at our hospital in both time frame comparisons as well as in West Regional Hospitals in March and April 2020 compared to March and April 2019 (p=0.0111, p=0.0215, and p=0.0414, respectively). Conclusion Stroke care has been disrupted by the COVID-19 pandemic worldwide. We identified a delay in LKWT to door as well as time from door to CT in March 2020 compared to March 2019 at our institution. There was a statistically significant decrease in final diagnosis of TIA at our hospital, all California hospitals, and all West Regional hospitals during the March-April 2020 window, suggesting that some patients with minor stroke symptoms may not be presenting to the hospital in the midst of the pandemic. Strategies to minimize delays in care and maximize functional recovery must continue to evolve as new challenges are met during the COVID-19 pandemic.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of the COVID-19 Pandemic on Stroke Patients

Ghanchi¹,

Takayanagi²,

Savla³

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…16 Defined and designated areas for all stroke patients and screening by an emergency room physician for suspected COVID-19 symptoms, with full protective gear (full-sleeved gown, surgical mask, eye protection (face shield and/or goggles), gloves, and head cover), have been proposed. 17 Since testing currently does not include a point-of-care device, universal precautions to healthcare workers become even more crucial.…”

Section: Acute Stroke Carementioning

confidence: 99%

The SARS‐CoV‐2/COVID‐19 pandemic and challenges in stroke care in India

Sylaja

Srivastava

Shah³

et al. 2020

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

Stroke care in India has evolved rapidly in the last decade with a focus on stroke awareness, prevention, rapid triage, treatment, and rehabilitation. But acute stroke care and poststroke rehabilitation in the country have limitations owing to the economic constraints and poor access to health care. The SARS-CoV-2/COVID-19 pandemic has made stroke care even more challenging. We outline the unfavorable circumstances in stroke care induced by the pandemic; propose mitigating measures; crisis management; and provide a comparative evaluation of stroke care between India and the United States during the pandemic. There is a need for public health systems in both developed and developing countries to improve awareness, implement proper strategies of triage, acute treatment, well-defined rehabilitation plans, telemedicine services, and virtual check-ins.

show abstract

“…Last, studies showed that SARS-CoV-2 invades human respiratory epithelial cells through its S-proteins and angiotensin-converting enzyme 2 (ACE2) receptors on human cells surface [7,25]. The expression and function of ACE2 receptor, normally reduced in hypertensive patients, is further reduced during SARS-CoV2 infection leading to a lower ability on controlling blood pressure [26].…”

Section: Covid-19 and Cerebrovascular Diseasesmentioning

confidence: 99%

Stroke care in Italy at the time of the COVID-19 pandemic: a lesson to learn

Bersano

Pantoni

2020

J Neurol

View full text Add to dashboard Cite

From March to May 2020, the Italian health care system, as many others, was almost entirely devoted to the fight against the COVID-19 pandemic. In this context, a number of questions arose, from the increased stroke risk due to COVID-19 infection to the quality of stroke patient care. The overwhelming need of COVID-19 patient management made mandatory a complete reorganization of the stroke pathways: many health professionals were reallocated and a number of stroke units was turned into COVID-19 wards. As a result, acute stroke care suffered from a shortage of services and delays in time-dependent treatments and diagnostic work-up. In-patient and outpatient care and rehabilitation facilities for stroke survivors were also reduced or slowed down, to direct resources to COVID-19 patients care and to reduce contagion risks. Overall, this is likely to result in a significant future increased burden of complications and disabilities that will impact the health care systems in the coming months. Thus, while still fighting against COVID-19 disease, authorities need to promptly implement robust action plans, including an increase of workforce, without forgetting the assurance of a high level of stroke care. The medical community and the health care administrators should always keep in mind that stroke was before, and will be after the pandemic, a, sometimes, life-threatening condition, and almost always a disease with a severe impact on the quality of life.

show abstract

Acute Stroke Care in the Coronavirus Disease 2019 Pandemic

Cited by 96 publications

References 15 publications

Effects of the COVID-19 Pandemic on Stroke Patients

Effects of the COVID-19 Pandemic on Stroke Patients

The SARS‐CoV‐2/COVID‐19 pandemic and challenges in stroke care in India

Stroke care in Italy at the time of the COVID-19 pandemic: a lesson to learn

Contact Info

Product

Resources

About