Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center

被引:134
作者
Siegler, J. E. [1 ]
Heslin, M. E. [2 ]
Thau, L. [2 ]
Smith, A. [1 ]
Jovin, T. G. [1 ]
机构
[1] Cooper Univ Hosp, Cooper Neurol Inst, 3 Cooper Plaza,Suite 320, Camden, NJ 08103 USA
[2] Rowan Univ, Cooper Med Sch, Camden, NJ 08103 USA
关键词
Epidemiology; Ischemic Stroke; Incidence; COVID-19; Coronavirus; SCALE;
D O I
10.1016/j.jstrokecerebrovasdis.2020.104953
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Introduction: Although there is evidence to suggest a high rate of cerebrovascular complications in patients with SARS-CoV-2 infection, anecdotal reports indicate a falling rate of new ischemic stroke diagnoses. We conducted an exploratory single-center analysis to estimate the change in number of new stroke diagnoses in our region, and evaluate the proximate reasons for this change during the COVID-19 pandemic at a tertiary care center in New Jersey. Patients and methods: A Comprehensive Stroke Center prospective cohort was retrospectively analyzed for the number of stroke admissions, demographic features, and short-term outcomes 5 months prior to 3/1/2020 (pre-COVID-19), and in the 6 weeks that followed (COVID-19 period). The primary outcome was the number of new acute stroke diagnoses before and during the COVID-19 period, as well as the potential reasons for a decline in the number of new diagnoses. Results: Of the 328 included patients, 53 (16%) presented in the COVID-19 period. There was a mean fall of 38% in new stroke diagnoses (mean 1.13/day [SD 1.07] from 1.82/day [SD 1.38], p<0.01), which was related to a 59% decline in the number of daily transfers from referral centers (p<0.01), 25% fewer telestroke consultations (p=0.08), and 55% fewer patients presenting directly to our institution by private vehicle (p<0.01) and 29% fewer patients through emergency services (p=0.09). There was no significant change in the monthly number of strokes due to large vessel occlusion (LVO), however the proportion of new LVOs nearly doubled in the COVID-19 period (38% vs. 21%, p=0.01). Conclusions: The observations at our tertiary care center corroborate anecdotal reports that the number of new stroke diagnoses is falling, which seems related to a smaller proportion of patients seeking healthcare services for milder symptoms. These preliminary data warrant validation in larger, multi-center studies. (C) 2020 Elsevier Inc. All rights reserved.
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页数:8
相关论文
共 31 条
[1]   CLASSIFICATION OF SUBTYPE OF ACUTE ISCHEMIC STROKE - DEFINITIONS FOR USE IN A MULTICENTER CLINICAL-TRIAL [J].
ADAMS, HP ;
BENDIXEN, BH ;
KAPPELLE, LJ ;
BILLER, J ;
LOVE, BB ;
GORDON, DL ;
MARSH, EE ;
KASE, CS ;
WOLF, PA ;
BABIKIAN, VL ;
LICATAGEHR, EE ;
ALLEN, N ;
BRASS, LM ;
FAYAD, PB ;
PAVALKIS, FJ ;
WEINBERGER, JM ;
TUHRIM, S ;
RUDOLPH, SH ;
HOROWITZ, DR ;
BITTON, A ;
MOHR, JP ;
SACCO, RL ;
CLAVIJO, M ;
ROSENBAUM, DM ;
SPARR, SA ;
KATZ, P ;
KLONOWSKI, E ;
CULEBRAS, A ;
CAREY, G ;
MARTIR, NI ;
FICARRA, C ;
HOGAN, EL ;
CARTER, T ;
GURECKI, P ;
MUNTZ, BK ;
RAMIREZLASSEPAS, M ;
TULLOCH, JW ;
QUINONES, MR ;
MENDEZ, M ;
ZHANG, SM ;
ALA, T ;
JOHNSTON, KC ;
ANDERSON, DC ;
TARREL, RM ;
NANCE, MA ;
BUDLIE, SR ;
DIERICH, M ;
HELGASON, CM ;
HIER, DB ;
SHAPIRO, RA .
STROKE, 1993, 24 (01) :35-41
[2]   Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].
Albers, G. W. ;
Marks, M. P. ;
Kemp, S. ;
Christensen, S. ;
Tsai, J. P. ;
Ortega-Gutierrez, S. ;
McTaggart, R. A. ;
Torbey, M. T. ;
Kim-Tenser, M. ;
Leslie-Mazwi, T. ;
Sarraj, A. ;
Kasner, S. E. ;
Ansari, S. A. ;
Yeatts, S. D. ;
Hamilton, S. ;
Mlynash, M. ;
Heit, J. J. ;
Zaharchuk, G. ;
Kim, S. ;
Carrozzella, J. ;
Palesch, Y. Y. ;
Demchuk, A. M. ;
Bammer, R. ;
Lavori, P. W. ;
Broderick, J. P. ;
Lansberg, M. G. .
NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718
[3]  
[Anonymous], 2020, ENGL J MED
[4]  
Centers for Disease Control and Prevention, COR DIS 19 CAS DAT S
[5]  
Centers for Disease Control and Prevention, PREP YOUR PRACT COV
[6]  
Chen S, 2020, JAMA Neurol, DOI [10.1101/2020.02.22.20026500, 10.1001/jamaneurol.2020.1127]
[7]   Acute Stroke Care in the Coronavirus Disease 2019 Pandemic [J].
Dafer, Rima M. ;
Osteraas, Nicholas D. ;
Biller, Jose .
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 2020, 29 (07)
[8]   Monomeric C-Reactive Protein and Cerebral Hemorrhage: From Bench to Bedside [J].
Di Napoli, Mario ;
Slevin, Mark ;
Popa-Wagner, Aurel ;
Singh, Puneetpal ;
Lattanzi, Simona ;
Divani, Afshin A. .
FRONTIERS IN IMMUNOLOGY, 2018, 9
[9]   An interactive web-based dashboard to track COVID-19 in real time [J].
Dong, Ensheng ;
Du, Hongru ;
Gardner, Lauren .
LANCET INFECTIOUS DISEASES, 2020, 20 (05) :533-534
[10]   Inflammatory risk factors, biomarkers and associated therapy in ischaemic stroke [J].
Esenwa, Charles C. ;
Elkind, Mitchell S. .
NATURE REVIEWS NEUROLOGY, 2016, 12 (10) :594-604