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Influence of the COVID-19 Pandemic on Treatment Times for Acute Ischemic Stroke: The Society of Vascular and Interventional Neurology Multicenter Collaboration.
Siegler, James E; Zha, Alicia M; Czap, Alexandra L; Ortega-Gutierrez, Santiago; Farooqui, Mudassir; Liebeskind, David S; Desai, Shashvat M; Hassan, Ameer E; Starosciak, Amy K; Linfante, Italo; Rai, Vivek; Thon, Jesse M; Then, Ryna; Heslin, Mark E; Thau, Lauren; Khandelwal, Priyank; Mohammaden, Mahmoud H; Haussen, Diogo C; Nogueira, Raul G; Jillella, Dinesh V; Nahab, Fadi; Kaliaev, Artem; Nguyen, Thanh N; Zaidat, Osama; Jovin, Tudor G; Jhadav, Ashutosh P.
  • Siegler JE; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.).
  • Zha AM; Department of Neurology, University of Texas Health Science Center at Houston, TX (A.M.Z., A.L.C.).
  • Czap AL; Department of Neurology, University of Texas Health Science Center at Houston, TX (A.M.Z., A.L.C.).
  • Ortega-Gutierrez S; Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics (S.O.-G., M.F.).
  • Farooqui M; Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics (S.O.-G., M.F.).
  • Liebeskind DS; Department of Neurology, Ronald Reagan University of California at Los Angeles (D.S.L.).
  • Desai SM; Department of Neurology, University of Pittsburgh Medical Center Mercy Hospital, PA (S.M.D., A.P.J.).
  • Hassan AE; Department of Neurology, University of Pittsburgh Medical Center Presbyterian Medical Center, PA (S.M.D., A.P.J.).
  • Starosciak AK; Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX (A.E.H.).
  • Linfante I; Center for Research (A.K.S.), Baptist Health South Florida, Coral Gables.
  • Rai V; Department of Interventional Neuroradiology and Endovascular Neurosurgery (I.L.), Baptist Health South Florida, Coral Gables.
  • Thon JM; OhioHealth Neuroscience Center, Riverside Methodist Hospital, Columbus (V.R.).
  • Then R; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.).
  • Heslin ME; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.).
  • Thau L; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.).
  • Khandelwal P; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.).
  • Mohammaden MH; Department of Endovascular Neurological Surgery and Neurology, Robert Wood Johnson University Hospital, New Brunswick, NJ (P.K.).
  • Haussen DC; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (M.H.M., D.C.H., R.G.N.).
  • Nogueira RG; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (M.H.M., D.C.H., R.G.N.).
  • Jillella DV; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (M.H.M., D.C.H., R.G.N.).
  • Nahab F; Department of Neurology, Emory University Hospital, Atlanta, GA (D.V.J., F.N.).
  • Kaliaev A; Department of Neurology, Emory University Hospital, Atlanta, GA (D.V.J., F.N.).
  • Nguyen TN; Department of Interventional Neurology and Neuroradiology, Boston Medical Center, MA (A.K., T.N.N.).
  • Zaidat O; Department of Interventional Neurology and Neuroradiology, Boston Medical Center, MA (A.K., T.N.N.).
  • Jovin TG; Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH (O.Z.).
  • Jhadav AP; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.).
Stroke ; 52(1): 40-47, 2021 01.
Article in English | MEDLINE | ID: covidwho-1050420
Semantic information from SemMedBD (by NLM)
1. Pandemics CAUSES COVID-19
Subject
Pandemics
Predicate
CAUSES
Object
COVID-19
2. Stroke Center LOCATION_OF Administration occupational activities
Subject
Stroke Center
Predicate
LOCATION_OF
Object
Administration occupational activities
3. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
4. COVID-19 COEXISTS_WITH Time from arrival at facility to administration of parenteral treatment
Subject
COVID-19
Predicate
COEXISTS_WITH
Object
Time from arrival at facility to administration of parenteral treatment
5. Puncture procedure NEG_TREATS Patients
Subject
Puncture procedure
Predicate
NEG_TREATS
Object
Patients
6. Thrombectomy TREATS Patients
Subject
Thrombectomy
Predicate
TREATS
Object
Patients
7. Evaluation TREATS Acute Ischemic Stroke
Subject
Evaluation
Predicate
TREATS
Object
Acute Ischemic Stroke
8. Pandemics CAUSES COVID-19
Subject
Pandemics
Predicate
CAUSES
Object
COVID-19
9. Stroke Center LOCATION_OF Administration occupational activities
Subject
Stroke Center
Predicate
LOCATION_OF
Object
Administration occupational activities
10. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
11. COVID-19 COEXISTS_WITH Time from arrival at facility to administration of parenteral treatment
Subject
COVID-19
Predicate
COEXISTS_WITH
Object
Time from arrival at facility to administration of parenteral treatment
12. Puncture procedure NEG_TREATS Patients
Subject
Puncture procedure
Predicate
NEG_TREATS
Object
Patients
13. Thrombectomy TREATS Patients
Subject
Thrombectomy
Predicate
TREATS
Object
Patients
14. Evaluation TREATS Acute Ischemic Stroke
Subject
Evaluation
Predicate
TREATS
Object
Acute Ischemic Stroke
ABSTRACT
BACKGROUND AND

PURPOSE:

The pandemic caused by the novel coronavirus disease 2019 (COVID-19) has led to an unprecedented paradigm shift in medical care. We sought to evaluate whether the COVID-19 pandemic may have contributed to delays in acute stroke management at comprehensive stroke centers.

METHODS:

Pooled clinical data of consecutive adult stroke patients from 14 US comprehensive stroke centers (January 1, 2019, to July 31, 2020) were queried. The rate of thrombolysis for nontransferred patients within the Target Stroke goal of 60 minutes was compared between patients admitted from March 1, 2019, and July 31, 2019 (pre-COVID-19), and March 1, 2020, to July 31, 2020 (COVID-19). The time from arrival to imaging and treatment with thrombolysis or thrombectomy, as continuous variables, were also assessed.

RESULTS:

Of the 2955 patients who met inclusion criteria, 1491 were admitted during the pre-COVID-19 period and 1464 were admitted during COVID-19, 15% of whom underwent intravenous thrombolysis. Patients treated during COVID-19 were at lower odds of receiving thrombolysis within 60 minutes of arrival (odds ratio, 0.61 [95% CI, 0.38-0.98]; P=0.04), with a median delay in door-to-needle time of 4 minutes (P=0.03). The lower odds of achieving treatment in the Target Stroke goal persisted after adjustment for all variables associated with earlier treatment (adjusted odds ratio, 0.55 [95% CI, 0.35-0.85]; P<0.01). The delay in thrombolysis appeared driven by the longer delay from imaging to bolus (median, 29 [interquartile range, 18-41] versus 22 [interquartile range, 13-37] minutes; P=0.02). There was no significant delay in door-to-groin puncture for patients who underwent thrombectomy (median, 83 [interquartile range, 63-133] versus 90 [interquartile range, 73-129] minutes; P=0.30). Delays in thrombolysis were observed in the months of June and July.

CONCLUSIONS:

Evaluation for acute ischemic stroke during the COVID-19 period was associated with a small but significant delay in intravenous thrombolysis but no significant delay in thrombectomy time metrics. Taking steps to reduce delays from imaging to bolus time has the potential to attenuate this collateral effect of the pandemic.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Time-to-Treatment / Ischemic Stroke / COVID-19 Subject: Time-to-Treatment / Ischemic Stroke / COVID-19 Language: English Journal: Stroke Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Time-to-Treatment / Ischemic Stroke / COVID-19 Subject: Time-to-Treatment / Ischemic Stroke / COVID-19 Language: English Journal: Stroke Year: 2021
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