The impact of the COVID-19 pandemic on a stroke center in Latin America

Silva, Marcus Tulius T.; Quintanilha, Giseli; Giesel, Louise; Soldati, Ana Beatriz; Jabarra, Carolina; Almeida, Cristina Vaz de; Rocha, Ligia Linardi Niero; Romão, Tayla Taynan; Sptiz, Clarissa; Soares, Cristiane; Ribeiro, Alex Sander; Damasceno, Moyses; Araújo, Abelardo; Lima, Marco Antônio

doi:10.1177/1747493020941637

Cited by 11 publications

(9 citation statements)

References 2 publications

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“…Regarding the treatment received by the patients, we could observe that there was no significant decrease in the patients who received IVT and/or EVT, this follows the line of other studies that show that although there was a decrease in the global number of IVT and EVT (9), this was proportional to the decrease in admitted patients, without changing the percentage of patients with reperfusion treatment (5). The increase in mortality, also observed in other studies, (5,10) can be explained by multiple factors, one of which is the greater severity of patients upon admission as measured by NIHSS, but there are several non-quantifiable factors such as saturation of patients in the emergency services, the reduced availability of critical wards and beds and the fatigue of health personnel as a result of the pandemic. Among the limitations of the study, it should be noted that it is an observational study, that the aetiology of the stroke or the percentage of occlusion of large vessel occlusion was not recorded and that the mortality measurement is in-hospital and not at 3 months.…”

Section: Discussionsupporting

confidence: 87%

Impact of COVID-19 Pandemic on Stroke Severity and Mortality in the South-East of Santiago, Chile

Silva-Pozo

Vallejos²,

Almeida

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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Section: Discussionsupporting

confidence: 87%

Impact of COVID-19 Pandemic on Stroke Severity and Mortality in the South-East of Santiago, Chile

Silva-Pozo

Vallejos²,

Almeida

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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“…Higher incidence of mortality and worse functional outcomes at discharge were reported in different cohort studies evaluating stroke patients who were admitted during the COVID-19 pandemic, compared with historical controls of the pre-COVID-19 period. 60,64,71,72,122–125 These alarming results may be attributable to delays in the presentation of stroke patients and subsequent lower rates of recanalization therapies. Furthermore, longer hospitalization stay was needed for the acute management of stroke patients during COVID-19 pandemic.…”

Section: Resultsmentioning

confidence: 99%

COVID-19 and cerebrovascular diseases: a comprehensive overview

Tsivgoulis

Palaiodimou

Zand

et al. 2020

Ther Adv Neurol Disord

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Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ to alarm clinicians in recognizing COVID-19-related stroke.

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“…A total of 52 studies reporting the impact of the COVID‐19 pandemic on stroke admissions were identified for qualitative synthesis. A total of 32,640 stroke admissions from 29 studies 6‐34 were included in the meta‐analysis (Figure 1) (Supplementary Table S1) based on a similar time frame of the study period and comparison period, of which ratios were derived, depending on each criterion data availability. Compared to the prepandemic period, the mean ratio of stroke admissions during the pandemic was 70.78% [95% CI: (65.02%, 76.54%)] (Figure 2) and the mean ratio of ICH cases was 83.10% [95% CI: (71.01%, 95.17%)] (Supplementary Figure S1).…”

Section: Resultsmentioning

confidence: 99%

A meta‐analysis of the global impact of the COVID‐19 pandemic on stroke care & the Houston Experience

Reddy

Satani

Beauchamp

et al. 2021

Ann Clin Transl Neurol

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Objective To review the global impact of the COVID‐19 pandemic on stroke care‐metrics and report data from a health system in Houston. Methods We performed a meta‐analysis of the published literature reporting stroke admissions, intracerebral hemorrhage (ICH) cases, number of thrombolysis (tPA) and thrombectomy (MT) cases, and time metrics (door to needle, DTN; and door to groin time, DTG) during the pandemic compared to prepandemic period. Within our hospital system, between January–June 2019 and January–June 2020, we compared the proportion of stroke admissions and door to tPA and MT times. Results A total of 32,640 stroke admissions from 29 studies were assessed. Compared to prepandemic period, the mean ratio of stroke admissions during the pandemic was 70.78% [95% CI, 65.02%, 76.54%], ICH cases was 83.10% [95% CI, 71.01%, 95.17%], tPA cases was 81.74% [95% CI, 72.33%, 91.16%], and MT cases was 88.63% [95% CI, 74.12%, 103.13%], whereas DTN time was 104.48% [95% CI, 95.52%, 113.44%] and DTG was 104.30% [95% CI, 81.99%, 126.61%]. In Houston, a total of 4808 cases were assessed. There was an initial drop of ~30% in cases at the pandemic onset. Compared to 2019, there was a significant reduction in mild strokes (NIHSS 1‐5) [N (%), 891 (43) vs 635 (40), P = 0.02]. There were similar mean (SD) (mins) DTN [44 (17) vs 42 (17), P = 0.14] but significantly prolonged DTG times [94 (15) vs 85 (20), P = 0.005] in 2020. Interpretation The COVID‐19 pandemic led to a global reduction in stroke admissions and treatment interventions and prolonged treatment time metrics.

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The impact of the COVID-19 pandemic on a stroke center in Latin America

Cited by 11 publications

References 2 publications

Impact of COVID-19 Pandemic on Stroke Severity and Mortality in the South-East of Santiago, Chile

Impact of COVID-19 Pandemic on Stroke Severity and Mortality in the South-East of Santiago, Chile

COVID-19 and cerebrovascular diseases: a comprehensive overview

A meta‐analysis of the global impact of the COVID‐19 pandemic on stroke care & the Houston Experience

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