School of Medicine Publications and Presentations
Influence of the COVID-19 Pandemic on Treatment Times for Acute Ischemic Stroke
Document Type
Article
Publication Date
11-30-2020
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
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.
Recommended Citation
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., … Jhadav Ashutosh P. (n.d.). Influence of the COVID-19 Pandemic on Treatment Times for Acute Ischemic Stroke. Stroke. https://doi.org/10.1161/STROKEAHA.120.032789
Publication Title
Stroke
DOI
10.1161/STROKEAHA.120.032789
Academic Level
faculty
Mentor/PI Department
Neurology
Comments
© 2020 American Heart Association, Inc.