Global Impact of COVID-19 on Stroke Care and IV Thrombolysis.
Raul G Nogueira, Muhammad M Qureshi, Mohamad Abdalkader, Sheila Ouriques Martins, Hiroshi Yamagami, Zhongming Qiu, Ossama Yassin Mansour, Anvitha Sathya, Anna Czlonkowska, Georgios Tsivgoulis, Diana Aguiar de Sousa, Jelle Demeestere, Robert Mikulik, Peter Vanacker, James E Siegler, Janika Kõrv, Jose Biller, Conrad W Liang, Navdeep S Sangha, Alicia M Zha, Alexandra L Czap, Christine Anne Holmstedt, Tanya N Turan, George Ntaios, Konark Malhotra, Ashis Tayal, Aaron Loochtan, Annamarei Ranta, Eva A Mistry, Anne W Alexandrov, David Y Huang, Shadi Yaghi, Eytan Raz, Sunil A Sheth, Mahmoud H Mohammaden, Michael Frankel, Eric Guemekane Bila Lamou, Hany M Aref, Ahmed Elbassiouny, Farouk Hassan, Tarek Menecie, Wessam Mustafa, Hossam M Shokri, Tamer Roushdy, Fred S Sarfo, Tolulope Oyetunde Alabi, Babawale Arabambi, Ernest O Nwazor, Taofiki Ajao Sunmonu, Kolawole Wahab, Joseph Yaria, Haytham Hussein Mohammed, Philip B Adebayo, Anis D Riahi, Samia Ben Sassi, Lenon Gwaunza, Gift Wilson Ngwende, David Sahakyan, Aminur Rahman, Zhibing Ai, Fanghui Bai, Zhenhui Duan, Yonggang Hao, Wenguo Huang, Guangwen Li, Wei Li, Ganzhe Liu, Jun Luo, Xianjin Shang, Yi Sui, Ling Tian, Hongbin Wen, Bo Wu, Yuying Yan, Zhengzhou Yuan, Hao Zhang, Jun Zhang, Wenlong Zhao, Wenjie Zi, Thomas W Leung, Chandril Chugh, Vikram Huded, Bindu Menon, Jeyaraj Durai Pandian, P N Sylaja, Fritz Sumantri Usman, Mehdi Farhoudi, Elyar Sadeghi Hokmabadi, Anat Horev, Anna Reznik, Rotem Sivan Hoffmann, Nobuyuki Ohara, Nobuyuki Sakai, Daisuke Watanabe, Ryoo Yamamoto, Ryosuke Doijiri, Naoki Tokuda, Takehiro Yamada, Tadashi Terasaki, Yukako Yazawa, Takeshi Uwatoko, Tomohisa Dembo, Hisao Shimizu, Yuri Sugiura, Fumio Miyashita, Hiroki Fukuda, Kosuke Miyake, Junsuke Shimbo, Yusuke Sugimura, Yoshiki Yagita, Yohei Takenobu, Yuji Matsumaru, Satoshi Yamada, Ryuhei Kono, Takuya Kanamaru, Hidekazu Yamazaki, Manabu Sakaguchi, Kenichi Todo, Nobuaki Yamamoto, Kazutaka Sonoda, Tomoko Yoshida, Hiroyuki Hashimoto, Ichiro Nakahara, Aida Kondybayeva, Kamila Faizullina, Saltanat Kamenova, Murat Zhanuzakov, Jang-Hyun Baek, Yangha Hwang, Jin Soo Lee, Si Baek Lee, Jusun Moon, Hyungjong Park, Jung Hwa Seo, Kwon-Duk Seo, Sung Il Sohn, Chang Jun Young, Rechdi Ahdab, Wan Asyraf Wan Zaidi, Zariah Abdul Aziz, Hamidon Bin Basri, Law Wan Chung, Aznita Binti Ibrahim, Khairul Azmi Ibrahim, Irene Looi, Wee Yong Tan, Nafisah Wan Yahya, Stanislav Groppa, Pavel Leahu, Amal M Al Hashmi, Yahia Zakaria Imam, Naveed Akhtar, Maria Carissa Pineda-Franks, Christian Oliver Co, Dmitriy Kandyba, Adel Alhazzani, Hosam Al-Jehani, Carol Huilian Tham, Marlie Jane Mamauag, Narayanaswamy Venketasubramanian, Chih-Hao Chen, Sung-Chun Tang, Anchalee Churojana, Esref Akil, Özlem Aykaç, Atilla Ozcan Ozdemir, Semih Giray, Syed Irteza Hussain, Seby John, Huynh Le Vu, Anh Duc Tran, Huy Hoang Nguyen, Thong Nhu Pham, Thang Huy Nguyen, Trung Quoc Nguyen, Thomas Gattringer, Christian Enzinger, Monika Killer-Oberpfalzer, Flavio Bellante, Sofie De Blauwe, Geert Vanhooren, Sylvie De Raedt, Anne Dusart, Robin Lemmens, Noemie Ligot, Matthieu Pierre Rutgers, Laetitia Yperzeele, Filip Alexiev, Teodora Sakelarova, Marina Roje Bedeković, Hrvoje Budincevic, Igor Cindric, Zlatko Hucika, David Ozretic, Majda Seferovic Saric, František Pfeifer, Igor Karpowic, David Cernik, Martin Sramek, Miroslav Skoda, Helena Hlavacova, Lukas Klecka, Martin Koutny, Daniel Vaclavik, Ondrej Skoda, Jan Fiksa, Katerina Hanelova, Miroslava Nevsimalova, Robert Rezek, Petr Prochazka, Gabriela Krejstova, Jiri Neumann, Marta Vachova, Henryk Brzezanski, David Hlinovsky, Dusan Tenora, Rene Jura, Lubomír Jurák, Jan Novak, Ales Novak, Zdenek Topinka, Petr Fibrich, Helena Sobolova, Ondrej Volny, Hanne Krarup Christensen, Nicolas Drenck, Helle Klingenberg Iversen, Claus Z Simonsen, Thomas Clement Truelsen, Troels Wienecke, Riina Vibo, Katrin Gross-Paju, Toomas Toomsoo, Katrin Antsov, Francois Caparros, Charlotte Cordonnier, Maria Dan, Jean-Marc Faucheux, Laura Mechtouff, Omer Eker, Emilie Lesaine, Basile Ondze, Roxane Peres, Fernando Pico, Michel Piotin, Raoul Pop, Francois Rouanet, Tatuli Gubeladze, Mirza Khinikadze, Nino Lobjanidze, Alexander Tsiskaridze, Simon Nagel, Peter Arthur Ringleb, Michael Rosenkranz, Holger Schmidt, Annahita Sedghi, Timo Siepmann, Kristina Szabo, Götz Thomalla, Lina Palaiodimou, Dimitrios Sagris, Odysseas Kargiotis, Peter Klivenyi, Laszlo Szapary, Gabor Tarkanyi, Alessandro Adami, Fabio Bandini, Paolo Calabresi, Giovanni Frisullo, Leonardo Renieri, Davide Sangalli, Anne Pirson, Maarten Uyttenboogaart, Ido van den Wijngaard, Espen Saxhaug Kristoffersen, Waldemar Brola, Małgorzata Fudala, Ewa Horoch-Lyszczarek, Michal Karlinski, Radoslaw Kazmierski, Pawel Kram, Marcin Rogoziewicz, Rafal Kaczorowski, Piotr Luchowski, Halina Sienkiewicz-Jarosz, Piotr Sobolewski, Waldemar Fryze, Anna Wisniewska, Malgorzata Wiszniewska, Patricia Ferreira, Paulo Ferreira, Luisa Fonseca, João Pedro Marto, Teresa Pinho E Melo, Ana Paiva Nunes, Miguel Rodrigues, Vítor Tedim Cruz, Cristian Falup-Pecurariu, Georgi Krastev, Miroslav Mako, María Alonso de Leciñana, Juan F Arenillas, Oscar Ayo-Martin, Antonio Cruz Culebras, Exuperio Diez Tejedor, Joan Montaner, Soledad Pérez-Sánchez, Miguel Angel Tola Arribas, Alejandro Rodriguez Vasquez, Michael Mayza, Gianmarco Bernava, Alex Brehm, Paolo Machi, Urs Fischer, Jan Gralla, Patrik L Michel, Marios-Nikos Psychogios, Davide Strambo, Soma Banerjee, Kailash Krishnan, Joseph Kwan, Asif Butt, Luciana Catanese, Andrew M Demchuk, Thalia Field, Jennifer Haynes, Michael D Hill, Houman Khosravani, Ariane Mackey, Aleksandra Pikula, Gustavo Saposnik, Courtney Anne Scott, Ashkan Shoamanesh, Ashfaq Shuaib, Samuel Yip, Miguel A Barboza, Jose Domingo Barrientos, Ligia Ibeth Portillo Rivera, Fernando Gongora-Rivera, Nelson Novarro-Escudero, Anmylene Blanco, Michael Abraham, Diana Alsbrook, Dorothea Altschul, Anthony J Alvarado-Ortiz, Ivo Bach, Aamir Badruddin, Nobl Barazangi, Charmaine Brereton, Alicia Castonguay, Seemant Chaturvedi, Saqib A Chaudry, Hana Choe, Jae H Choi, Sushrut Dharmadhikari, Kinjal Desai, Thomas G Devlin, Vinodh T Doss, Randall Edgell, Mark Etherton, Mudassir Farooqui, Don Frei, Dheeraj Gandhi, Mikayel Grigoryan, Rishi Gupta, Ameer E Hassan, Johanna Helenius, Artem Kaliaev, Ritesh Kaushal, Priyank Khandelwal, Ayaz M Khawaja, Naim N Khoury, Benny S Kim, Dawn O Kleindorfer, Feliks Koyfman, Vivien H Lee, Lester Y Leung, Guillermo Linares, Italo Linfante, Helmi L Lutsep, Lisa Macdougall, Shailesh Male, Amer M Malik, Hesham Masoud, Molly McDermott, Brijesh P Mehta, Jiangyong Min, Manoj Mittal, Jane G Morris, Sumeet S Multani, Fadi Nahab, Krishna Nalleballe, Claude B Nguyen, Roberta Novakovic-White, Santiago Ortega-Gutierrez, Rahul H Rahangdale, Pankajavalli Ramakrishnan, Jose Rafael Romero, Natalia Rost, Aaron Rothstein, Sean Ruland, Ruchir Shah, Malveeka Sharma, Brian Silver, Marc Simmons, Abhishek Singh, Amy K Starosciak, Sheryl L Strasser, Viktor Szeder, Mohamed Teleb, Jenny P Tsai, Barbara Voetsch, Oscar Balaguera, Virginia A Pujol Lereis, Adriana Luraschi, Marcele Schettini Almeida, Fabricio Buchdid Cardoso, Adriana Conforto, Leonardo De Deus Silva, Luidia Varrone Giacomini, Fabricio Oliveira Lima, Alexandre L Longo, Pedro S C Magalhães, Rodrigo Targa Martins, Francisco Mont'alverne, Daissy Liliana Mora Cuervo, Leticia Costa Rebello, Lenise Valler, Viviane Flumignan Zetola, Pablo M Lavados, Victor Navia, Verónica V Olavarría, Juan Manuel Almeida Toro, Pablo Felipe Ricardo Amaya, Hernan Bayona, Angel Corredor, Carlos Eduardo Rivera Ordonez, Diana Katherine Mantilla Barbosa, Osvaldo Lara, Mauricio R Patiño, Luis Fernando Diaz Escobar, Donoband Edson Dejesus Melgarejo Fariña, Analia Cardozo Villamayor, Adolfo Javier Zelaya Zarza, Danny Moises Barrientos Iman, Liliana Rodriguez Kadota, Bruce Campbell, Graeme J Hankey, Casey Hair, Timothy Kleinig, Alice Ma, Rodrigo Tomazini Martins, Ramesh Sahathevan, Vincent Thijs, Daniel Salazar, Teddy Yuan-Hao Wu, Diogo C Haussen, David Liebeskind, Dileep R Yavagal, Tudor G Jovin, Osama O Zaidat, Thanh N NguyenOBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.
METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.
RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions.
CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.
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