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Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

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  • Raul G Nogueira
  • Muhammed M Qureshi
  • Mohamad Abdalkader
  • Sheila Ouriques Martins
  • Hiroshi Yamagami
  • Zhongming Qiu
  • Ossama Yassin Mansour
  • Anvitha Sathya
  • Anna Czlonkowska
  • Georgios Tsivgoulis
  • Diana Aguiar de Sousa
  • Jelle Demeestere
  • Robert Mikulik
  • Peter Vanacker
  • James E Siegler
  • Janika Kõrv
  • Jose Biller
  • Conrad W Liang
  • Navdeep S Sangha
  • Alicia M Zha
  • Alexandra L Czap
  • Christine Anne Holmstedt
  • Tanya N Turan
  • George Ntaios
  • Konark Malhotra
  • Ashis Tayal
  • Aaron Loochtan
  • Annamarei Ranta
  • Eva A Mistry
  • Anne W Alexandrov
  • David Y Huang
  • Shadi Yaghi
  • Eytan Raz
  • Sunil A Sheth
  • Mahmoud H Mohammaden
  • Michael Frankel
  • Eric Guemekane Bila Lamou
  • Hany M Aref
  • Ahmed Elbassiouny
  • Farouk Hassan
  • Tarek Menecie
  • Wessam Mustafa
  • Hossam M Shokri
  • Tamer Roushdy
  • Fred S Sarfo
  • Tolulope Oyetunde Alabi
  • Hanne Krarup Christensen
  • Helle Klingenberg Iversen
  • Thomas Clement Truelsen
  • Troels Wienecke
  • SVIN COVID-19 Global Stroke Registry
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OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.

METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.

RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions.

CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

Original languageEnglish
JournalNeurology
Volume96
Issue number23
Pages (from-to)e2824-e2838
ISSN0028-3878
DOIs
Publication statusPublished - 8 Jun 2021

ID: 65610072