ABSTRACT
Objective: To determine how implementation of Society for Neurointerventional Surgery (SNIS) guidelines affected outcomes for ischemic stroke patients. Background: SNIS issued guidelines for patient management during the coronavirus disease 2019 (COVID-19) pandemic. Recommendations include intubating COVID-19 positive and unknown COVID-19 status patients prior to endovascular thrombectomy, cohorting by COVID-19 status, early discharge, and postponing elective cases. Design/Methods: This was a retrospective cohort study comparing ischemic stroke patients treated with thrombectomy during the COVID-19 pandemic peak (4/1/20-6/30/20) to those treated in 2019 (4/1/19-6/30/19). Statistical tests used for analysis included Kruskal-Wallis, chisquared and Fisher's exact test. Results: There were 112 ischemic stroke patients treated with thrombectomy: 55 (49%) in 2019 and 57 (51%) during the COVID-19 peak. There were no differences in thrombectomy among all ischemic stroke admissions in 2019 vs. the COVID-19 peak (22% vs. 24%, p=0.67). COVID- 19 testing was performed in 29 (51%) patients;none were positive. The median age was 68 in 2019 and 69 during the COVID-19 peak, p=0.28;other characteristics were similar. Compared to 2019, a significantly higher proportion of patients were intubated during the COVID-19 peak (96% vs. 45%, p<0.0001). The median days to extubation was 2 days for both groups, p=0.31. The proportion of patients re-intubated was 2% in 2019 vs. 5% during the COVID-19 peak, p=0.95. The median time to groin puncture was significantly shorter in 2019 than during the COVID-19 peak, 38 vs 43 minutes, p=0.002. The TICI score and mRS were similar between groups, p=0.26 and p=0.84, respectively. Conclusions: After implementing SNIS guidelines, including pre-treatment intubation, we observed a statistically significant but not clinically meaningful increased time to groin puncture, which did not negatively impact outcomes. These results suggest hospitals who manage patients efficiently can implement safe management practices in response to COVID-19 without impacting outcomes. We recommend following SNIS guidelines to prevent the spread of COVID-19.
ABSTRACT
Objective: To determine how coronavirus disease 2019 (COVID-19) impacted stroke patient admission volumes. Background: To prevent the spread of COVID-19 social distancing guidelines were implemented and many institutions postponed elective procedures. Delayed hospital admission has been reported due to fear of infection. Design/Methods: This retrospective cohort study compared stroke patients admitted to a comprehensive stroke center during the COVID-19 pandemic 4/1/20-6/30/20 "COVID-19 peak" to patients admitted 4/1/19-6/30/19 "2019". Characteristics and outcomes were compared using chi-squared, Fisher's exact, and the Kruskal-Wallis test. Results: There were 651 stroke admissions: 341 (52%) in 2019, 310 (48%) during the COVID-19 peak;overall a 9% decrease. The median number of admissions per day was 4 in 2019 and 3 during the COVID-19 peak, p=0.21. The proportion of patients by stroke type was not significantly different in 2019 compared to the COVID-19 peak: Ischemic stroke (75% vs. 76%, p=0.69);hemorrhagic stroke (16% vs. 18%, p=0.39);transient ischemic attacks (11% vs. 7%, p=0.10). The median age was 70 years in both 2019 and during the COVID-19 peak, p=0.64;other demographic characteristics were comparable. The time from onset to arrival was 273 minutes in 2019 vs. 263 minutes during COVID-19 peak, p=0.46;24% were transfers in 2019 vs. 23% during the COVID-19 peak (p=0.72). The median length of stay (4 days, p=0.52) and the median discharge mRS (3, p=0.31) was identical in 2019 compared to the COVID-19 peak. Of the 113 patients tested for COVID-19, 4% were positive. Conclusions: Although many centers have reported a significant decrease in stroke patient admissions, the COVID-19 pandemic did not significantly affect patient volume or the time from onset to arrival at our institution. As the pandemic continues, it is important for hospitals to be informed that COVID-19 may not impact stroke volume, so providers are prepared to manage both stroke and COVID-19 patients efficiently.
ABSTRACT
Introduction: As a result of the novel coronavirus 2019 (COVID-19) pandemic, the Society for Neurointerventional Surgery (SNIS) issued guidelines for patient management during COVID-19. Specifically, they suggested intubating COVID-19 positive or those with unknown COVID-19 status prior to emergent endovascular thrombectomy, cohorting by COVID-19 status, early ICU discharge, and postponing elective cases. We sought to determine how the implementation of SNIS guidelines affected outcomes for patients with ischemic stroke. Methods: This was a retrospective cohort study comparing ischemic stroke patients who were treated with thrombectomy admitted during the COVID-19 pandemic 4/1/20-6/30/20 “COVID-19 peak” to patients admitted 4/1/19-6/30/19 “2019”. Statistical tests used for analysis included Kruskal- Wallis, chi-squared and Fisher's exact test. Results: The proportion of patients treated with thrombectomy was not significantly different, 23% in 2019 vs. 24% during the COVID-19 peak, p=0.67. There were 112 patients treated with thrombectomy: 57 (51%) in 2019, 55 (49%) during the COVID-19 peak. No patients treated with thrombectomy were positive for COVID-19, but 27 (49%) were tested. The median age was 69 for those treated in 2019 and 69 for those during the COVID-19 peak, p=0.44. Patients were similar in sex, race, and comorbidities. The time from onset to arrival was also statistically similar, p=0.19. In 2019, 16% received tPA compared to 9% during the COVID-19 peak, p=0.28. The median time to groin puncture was significantly shorter in 2019, 38 minutes, than during the COVID-19 peak, 44 minutes, p=0.01. The recanalization rate and mRS were similar between groups, p=0.06, and p=0.91, respectively. Conclusions: After implementing the SNIS guidelines, including pre-treatment intubation, we observed a significantly longer time to groin puncture. Anecdotally, the increased observed was remarkably small given the changes to care and did not negatively impact patient outcomes. This suggests that hospitals managing patients efficiently can implement changes in response to COVID- 19 and continue high level of care without impacting outcomes. Therefore, we recommend following the SNIS guidelines to prevent the spread of COVID-19.