Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: The Society of Vascular and Interventional Neurology Multicenter Collaboration.
Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: The Society of Vascular and Interventional Neurology Multicenter Collaboration.
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DOI：
10.1016/j.clineuro.2020.106436
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发表时间：
2021-03
影响因子：
1.9
通讯作者：
SVIN COVID-19 Multinational Registry and Task Force
中科院分区：
文献类型：
--
作者：
Ortega-Gutierrez S;Farooqui M;Zha A;Czap A;Sebaugh J;Desai S;Jadhav A;Vora N;Rai V;Jovin TG;Thon JM;Heslin M;Thau L;Zevallos C;Quispe-Orozco D;Jillella DV;Nahab F;Mohammaden MH;Nogueira RG;Haussen DC;Nguyen TN;Romero JR;Aparicio HJ;Osman M;Haq IU;Liebeskind D;Hassan AE;Zaidat O;Siegler JE;SVIN COVID-19 Multinational Registry and Task Force
在一项来自美国8个州的多中心观察性研究中，评价COVID-19大流行期间的总体缺血性卒中量和发生率、特定亚型和临床表现。我们比较了2019年1月至2020年5月期间收治的所有缺血性卒中，分为2020年3月至5月（COVID-19期间）和2019年3月至5月（季节性COVID-19前期）。主要结局是入院时的卒中严重程度，通过NIHSS分为轻度（0 - 7）、中度和重度（>14）。次要结局是大血管闭塞（LVO）的体积、卒中病因、IV-tPA率和出院处置。在研究期间诊断为急性缺血性卒中的7969例患者中，933例（12%）出现在COVID-19期间，1319例（17%）出现在季节性COVID-19前期。观察到新诊断的缺血性卒中的平均每周数量显著下降（98 ± 3 vs 50 ± 20，p = 0.003），LVO（16.5 ± 3.8 vs 8.3 ± 5.9，p = 0.008），IV-tPA（10.9 ± 3.4 vs 5.3 ± 2.9，p = 0.0047），而每周LVO的平均比例（18% ± 5vs.16% ±7，p = 0.24）和IV-tPA（10.4% ± 4.5vs.9.9% ± 2.4，p = 0.66）保持不变。此外，在COVID-19期间，出现严重疾病（NIHSS > 14）的患者比例增加（29.7% vs 24.5%，p < 0.025）。与季节性COVID-19前相比，COVID-19期间出院回家的几率增加了26%（OR：1. 26，95% CI：1. 07 - 1. 49，p = 0. 016）。在COVID-19期间，新诊断的缺血性卒中病例和IV-tPA给药数量减少。入院的患者有严重的神经系统临床表现，更有可能出院回家。
To evaluate overall ischemic stroke volumes and rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US. We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as; March-May 2020 (COVID-19 period) and March-May 2019 (seasonal pre-COVID-19 period). Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0−7), moderate, and severe (>14). Secondary outcomes were volume of large vessel occlusions (LVOs), stroke etiology, IV-tPA rates, and discharge disposition. Of the 7969 patients diagnosed with acute ischemic stroke during the study period, 933 (12 %) presented in the COVID-19 period while 1319 (17 %) presented in the seasonal pre-COVID-19 period. Significant decline was observed in the mean weekly volumes of newly diagnosed ischemic strokes (98 ± 3 vs 50 ± 20,p = 0.003), LVOs (16.5 ± 3.8 vs 8.3 ± 5.9,p = 0.008), and IV-tPA (10.9 ± 3.4 vs 5.3 ± 2.9,p = 0.0047), whereas the mean weekly proportion of LVOs (18 % ±5 vs 16 % ±7,p = 0.24) and IV-tPA (10.4 % ±4.5 vs. 9.9 % ±2.4,p = 0.66) remained the same, when compared to the seasonal pre-COVID-19 period. Additionally, an increased proportion of patients presented with a severe disease (NIHSS > 14) during the COVID-19 period (29.7 % vs 24.5 %,p < 0.025). The odds of being discharged to home were 26 % greater in the COVID-19 period when compared to seasonal pre-COVID-19 period (OR:1.26, 95 % CI:1.07–1.49,p = 0.016). During COVID-19 period there was a decrease in volume of newly diagnosed ischemic stroke cases and IV-tPA administration. Patients admitted to the hospital had severe neurological clinical presentation and were more likely to discharge home.
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