Stroke management pathway during COVID-19 pandemic scientific statement by the Saudi Stroke Society

Alzahrani, Saeed S; Aleisa, Farah; Alghalbi, Jamilah A; Taher, Nouran Y; Alqahtani, Saeed A; Majrashi, Nabat A; Alasseri, Areej A; Alghamdi, Saeed

doi:10.17712/nsj.2020.3.20200079

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…With the higher severity of COVID-19, the use of anti-diabetic medications such as DPP4 Inhibitors and their effects are currently being studied [112][113][114]. While multiple changes have been established in the effective management of new cases of stroke in COVID-19 positive patients, guidelines for COVID-19 patients with a past history of cerebrovascular disease have followed the hypertensive and the diabetic protocols due to their close relationship in the pathophysiology [115][116][117][118][119][120][121][122][123][124].…”

Section: Discussionmentioning

confidence: 99%

Hypertension, diabetes mellitus, and cerebrovascular disease predispose to a more severe outcome of COVID-19

Ramphul¹,

Lohana²,

Ramphul³

et al. 2021

Arch Med Sci Atheroscler Dis

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Introduction The world is currently facing the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The total number of cases of coronavirus disease 2019 (COVID-19) is rising daily and no vaccine has yet been approved. While the pathophysiology behind the virus is still being studied, many possible several risk factors using small sample sizes have been found. Material and methods We conducted a pooled analysis using several databases such as Medline, Scopus, Wangfang, Web of Science, Research Square, medrxiv, and Google Scholar to identify studies reporting severe and non-severe groups of COVID-19 patients. The odds ratios as well as the 95% confidence intervals for hypertension, diabetes, and cerebrovascular disease leading to severe COVID-19 were calculated using R-software. Results Fifty-three articles were used for our analysis and they involved 30,935 confirmed cases of COVID-19 from several countries across the world. The odds ratio for severe COVID-19 in hypertensive patients, diabetics, and patients with a history of cerebrovascular disease was 2.58 (95% confidence interval (CI): 2.16–3.08, from 53 studies), 2.17 (95% CI: 1.72–2.74, from 44 studies), and 2.63 (95% CI: 1.80–3.85, from 25 studies), respectively. Conclusions Our analysis confirms that patients with hypertension, diabetes, or cerebrovascular disease are at a higher risk of a severe outcome of COVID-19. It is thus vital for physicians to identify the main risk factors for a severe outcome of this disease.

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Section: Discussionmentioning

confidence: 99%

Hypertension, diabetes mellitus, and cerebrovascular disease predispose to a more severe outcome of COVID-19

Ramphul¹,

Lohana²,

Ramphul³

et al. 2021

Arch Med Sci Atheroscler Dis

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show abstract

“…Recommendations covering the areas of education, screening, imaging, treatment, transfer, discharge, and follow-up procedures have been published. A number of publications have highlighted the importance of improving educational outreach for health professionals and the public, particularly those at high risk of stroke, to recognize stroke and call emergency medical services (EMS), thus avoiding significant delays and worse outcomes [12,13,19,26,27]. To minimize risk of infection, many guidelines suggest screening for COVID-19 symptoms and exposure as soon as possible, including remotely or by EMS, and communicating the results to the stroke team [14,16,18,20,22,25].…”

Section: Suggested Guidelines For Stroke Carementioning

confidence: 99%

“…Recommended strategies regarding imaging include establishing a COVID-specific scanner [16,17] and performing magnetic resonance imaging (MRI) first so that patients do not require multiple scanning sessions [25]. Identification of transient ischemic attacks (TIAs) and mild strokes without deficits and no indication for emergent treatment could be addressed with remote management [14,25,26]. While most published recommendations indicate that established guidelines should be followed regarding treatment, French interventionalists suggest withholding treatment from patients in the ICU who test positive for COVID-19 [22] and others suggest remote review of treatment eligibility, including functional exams [10,25].…”

Section: Suggested Guidelines For Stroke Carementioning

confidence: 99%

“…Rapid discharge of patients who can be managed at home [12,14,17,25] and remote follow-up consultations [12,14,17,19,20,22,27] are also mentioned as strategies. Finally, early recognition of the need for transport to a designated stroke center can reduce interfacility transfers, effectuating a reduction in potential infectious exposure [26].…”

Section: Suggested Guidelines For Stroke Carementioning

confidence: 99%

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Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?

Dula¹,

Brown²,

Aggarwal³

et al. 2020

JMIR Aging

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Despite the evidence suggesting a high rate of cerebrovascular complications in patients with SARS-CoV-2, reports have indicated decreasing rates of new ischemic stroke diagnoses during the COVID-19 pandemic. The observed decrease in emergency department (ED) visits is unsurprising during this major crisis, as patients are likely to prioritize avoiding exposure to SARS-CoV-2 over addressing what they may perceive as mild symptoms of headache, lethargy, difficulty speaking, and numbness. In the central and south Texas regions where we practice, we suspect that patient admission, treatment, and discharge volumes for acute stroke treatment have decreased significantly since COVID-19–related shelter-at-home orders were issued. Symptoms of stroke are frequently noticed by a family member, friend, or community member before they are recognized by the patients themselves, and these symptoms may be going unnoticed due to limited face-to-face encounters. This possibility emphasizes the importance of patient education regarding stroke warning signs and symptoms during the current period of isolation and social-distancing. The south Texas population, already saddled with above-average rates of cardiovascular and cerebrovascular disease, has a higher stroke mortality rate compared to Texas and U.S. averages; however, the number of patients presenting to EDs with acute ischemic stroke diagnoses is lower than average. In our viewpoint, we aim to present the relative literature to date and outline our ongoing analyses of the highly affected and diverse stroke populations in San Antonio and Austin, Texas, to answer a simple question: where did all our stroke patients go?

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“…During the COVID-19 pandemic many local and international protocols have been developed to protect healthcare workers and other patients (10,11). A better understanding of the effects the COVID-19 pandemic has had on stroke codes could lead to more safe approaches to acute stroke care.…”

Section: Discussionmentioning

confidence: 99%

Stroke Codes during the COVID-19 Pandemic: Clinical Characteristics

Kajtazi¹,

Almalki²,

Tleyjeh³

et al. 2021

J Clin Neurol Neurosci

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Background and Purpose:The COVID-19 pandemic has affected stroke care delivery. New triage systems have affected the code stroke process and lead to longer treatment times. We aimed to describe the clinical features of stroke during the pandemic and its' effect on the code stroke process.Methods: A descriptive, non-experimental, cross-sectional study was conducted in all stroke codes between March 1, 2020, and June 30, 2020. Demographic data, vascular risk factors, clinical symptoms (both neurological and respiratory), clinical exam finding, COVID-19 screening score, final clinical diagnosis, and use of thrombolytics and COVID-19 PCR results were collected. Chi-square, Fisher's exact test, Student's t-test, and the Mann-Whitney U test were used to compare the demographics and clinical characteristics between COVID-19 positive and negative patients.Results: Of 202 code strokes, 14% were COVID-19 positive. Fortyfive percent of stroke codes were diagnosed with stroke or transient ischemic attack. COVID-19 patients were on average 5 years younger. Stroke code rates dropped in March 2020 compared to 2019, then increased gradually. COVID-19 positive patients were more likely to present with symptoms and signs suggestive of large vessel disease. Respiratory symptoms (fever, cough, and shortness of breath) were more likely to be seen in COVID-19 positive patients. The COVID-19 triage checklist score was higher in the COVID-19 positive patients (5.7 vs 3.7). A checklist score of 4 or less was seen in 32% of COVID-19 positive patients compared to 52% of COVID-19 negative patients. Fourteen percent of stroke or transient ischemic attack (TIA) vs no stroke or TIA were COVID-19 positive. A deviation of trend in stroke code activation for non-citizens was observed.

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Stroke management pathway during COVID-19 pandemic scientific statement by the Saudi Stroke Society

Cited by 3 publications

References 10 publications

Hypertension, diabetes mellitus, and cerebrovascular disease predispose to a more severe outcome of COVID-19

Hypertension, diabetes mellitus, and cerebrovascular disease predispose to a more severe outcome of COVID-19

Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?

Stroke Codes during the COVID-19 Pandemic: Clinical Characteristics

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