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1.
J Am Heart Assoc ; 10(14): e021046, 2021 07 20.
Article in English | MEDLINE | ID: covidwho-1463078

ABSTRACT

Background Acute ischemic stroke (AIS) in the context of COVID-19 has received considerable attention for its propensity to affect patients of all ages. We aimed to evaluate the effect of age on functional outcome and mortality following an acute ischemic event. Methods and Results A prospectively maintained database from comprehensive stroke centers in Canada and the United States was analyzed for patients with AIS from March 14 to September 30, 2020 who tested positive for SARS-CoV-2. The primary outcome was Modified Rankin Scale score at discharge, and the secondary outcome was mortality. Baseline characteristics, laboratory values, imaging, and thrombectomy workflow process times were assessed. Among all 126 patients with COVID-19 who were diagnosed with AIS, the median age was 63 years (range, 27-94). There were 35 (27.8%) patients with AIS in the aged ≤55 years group, 47 (37.3%) in the aged 56 to 70 group, and 44 (34.9%) in the aged >70 group. Intravenous tissue plasminogen activator and thrombectomy rates were comparable across these groups, (P=0.331 and 0.212, respectively). There was a significantly lower rate of mortality between each group favoring younger age (21.9% versus 45.0% versus 48.8%, P=0.047). After multivariable adjustment for possible confounders, a 1-year increase in age was significantly associated with fewer instances of a favorable outcome of Modified Rankin Scale 0 to 2 (odds ratio [OR], 0.95; 95 CI%, 0.90-0.99; P=0.048) and higher mortality (OR, 1.06; 95 CI%, 1.02-1.10; P=0.007). Conclusions AIS in the context of COVID-19 affects young patients at much greater rates than pre-pandemic controls. Nevertheless, instances of poor functional outcome and mortality are closely tied to increasing age.


Subject(s)
COVID-19/complications , Ischemic Stroke/etiology , Adult , Age Factors , Aged , Aged, 80 and over , Canada , Female , Humans , Ischemic Stroke/mortality , Ischemic Stroke/therapy , Male , Middle Aged , Prospective Studies , United States
2.
Stroke ; 52(4): 1527-1531, 2021 04.
Article in English | MEDLINE | ID: covidwho-1085244

ABSTRACT

Informed consent is a key concept to ensure patient autonomy in clinical trials and routine care. The coronavirus disease 2019 (COVID-19) pandemic has complicated informed consent processes, due to physical distancing precautions and increased physician workload. As such, obtaining timely and adequate patient consent has become a bottleneck for many clinical trials. However, this challenging situation might also present an opportunity to rethink and reappraise our approach to consent in clinical trials. This viewpoint discusses the challenges related to informed consent during the COVID-19 pandemic, whether it could be acceptable to alter current consent processes under these circumstances, and outlines a possible framework with predefined criteria and a system of checks and balances that could allow for alterations of existing consent processes to maximize patient benefit under exceptional circumstances such as the COVID-19 pandemic without undermining patient autonomy.


Subject(s)
COVID-19 , Informed Consent/standards , Pandemics , Randomized Controlled Trials as Topic/standards , Stroke/diagnostic imaging , Stroke/therapy , Aged , COVID-19/epidemiology , Humans , Male , Stroke/epidemiology , Time Factors
5.
Stroke ; 51(7): 2273-2275, 2020 07.
Article in English | MEDLINE | ID: covidwho-327109

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, infectious disease control is of utmost importance in acute stroke treatment. This is a new situation for most stroke teams that often leads to uncertainty among physicians, nurses, and technicians who are in immediate contact with patients. The situation is made even more complicated by numerous new regulations and protocols that are released in rapid succession. Herein, we are describing our experience with simulation training for COVID-19 stroke treatment protocols. One week of simulation training allowed us to identify numerous latent safety threats and to adjust our institution-specific protocols to mitigate them. It also helped our physicians and nurses to practice relevant tasks and behavioral patterns (eg, proper donning and doffing PPE, where to dispose potentially contaminated equipment) to minimize their infectious exposure and to adapt to the new situation. We therefore strongly encourage other hospitals to adopt simulation training to prepare their medical teams for code strokes during the COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections , Neurology/education , Pandemics , Personnel, Hospital/education , Pneumonia, Viral , Simulation Training , Stroke/therapy , Airway Management/methods , COVID-19 , Communication Barriers , Coronavirus Infections/prevention & control , Endovascular Procedures/education , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Occupational Diseases/prevention & control , Pandemics/prevention & control , Patient Safety , Personal Protective Equipment , Personnel, Hospital/psychology , Pneumonia, Viral/prevention & control , Procedures and Techniques Utilization , Protective Devices , SARS-CoV-2 , Stress, Psychological/prevention & control , Thrombectomy/education , Thrombectomy/methods , Thrombolytic Therapy/methods , Time-to-Treatment
6.
Stroke ; 51(7): 2263-2267, 2020 07.
Article in English | MEDLINE | ID: covidwho-247793

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has broad implications on stroke patient triage. Emergency medical services providers have to ensure timely transfer of patients while minimizing the risk of infectious exposure for themselves, their co-workers, and other patients. This statement paper provides a conceptual framework for acute stroke patient triage and transfer during the COVID-19 pandemic and similar healthcare emergencies in the future.


Subject(s)
Betacoronavirus , Emergency Medical Services/statistics & numerical data , Pandemics , Stroke/epidemiology , Triage , Acute Disease , Asymptomatic Diseases , COVID-19 , Canada/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Delayed Diagnosis , Equipment Contamination , Health Workforce , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Occupational Diseases/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Protective Devices , Resource Allocation , SARS-CoV-2 , Stroke/complications , Stroke/diagnosis , Stroke/therapy , Symptom Assessment , Time-to-Treatment , Transportation of Patients , Travel , Triage/methods , Triage/standards , Unconsciousness/etiology , Workflow
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