Global impact of COVID-19 on stroke care
Raul G. Nogueira, Mohamad Abdalkader, Muhammed M. Qureshi, Michael Frankel, Malek Mansour, Hiroshi Yamagami, Zhongming Qiu, Mehdi Farhoudi, James E. Siegler, Shadi Yaghi, Eytan Raz, Nobuyuki Sakai, Nobuyuki Ohara, Michel Piotin, Laura Mechtouff, Omer Eker, Vanessa Chalumeau, Timothy Kleinig, Raoul Pop, Jianmin Liu, Hugh Stephen Winters, Xianjin Shang, Alejandro Rodríguez Vásquez, Jordi Blasco, Juan F. Arenillas, Mario Martínez‐Galdámez, Alex Brehm, Marios‐Nikos Psychogios, Pedro Lylyk, Diogo C Haussen, Alhamza R Al‐Bayati, Mahmoud Mohammaden, Luísa Fonseca, M Luís Silva, Francisco Mont’Alverne, Leonardo Renieri, Salvatore Mangiafico, Urs Fischer, Jan Gralla, Donald Frei, Chandril Chugh, Brijesh Mehta, Simon Nagel, Markus Möhlenbruch, Santiago Ortega‐Gutiérrez, Mudassir Farooqui, Ameer E Hassan, Allan Taylor, Bertrand Lapergue, Arturo Consoli, Bruce Campbell, Malveeka Sharma, Melanie Walker, Noel van Horn, Jens Fiehler, Huy Thang Nguyen, Quoc T. Nguyen, Daisuke Watanabe, Hao Zhang, Huynh Vu Le, Viet Q. Nguyen, Ruchir Shah, Thomas Devlin, Priyank Khandelwal, Italo Linfante, Wazim Izzath, Pablo M. Lavados, Verónica V. Olavarría, Gisele Sampaio Silva, Anna Verena de Carvalho Sousa, Jawad F. Kirmani, Martin Bendszus, Tatsuo Amano, Ryoo Yamamoto, Ryosuke Doijiri, Naoki Tokuda, Takehiro Yamada, Tadashi Terasaki, Yukako Yazawa, Jane G. Morris, Emma Griffin, John Thornton, Pascale Lavoie, Charles Matouk, Michael D. Hill, Andrew M. Demchuk, Monika Killer‐Oberpfalzer, Fadi Nahab, Dorothea Altschul, Anna Ramos‐Pachón, Natàlia Pérez de la Ossa, Raghid Kikano, William Boisseau, Gregory Walker, Steve M Cordina, Ajit S Puri, Anna Luisa Kühn, Dheeraj Gandhi, Pankajavalli Ramakrishnan, Roberta Novakovic‐White
Abstract
BACKGROUND: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. AIMS: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior). METHODS: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. RESULTS: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, -19.7 to -18.7), 11.5% (95%CI, -12.6 to -10.6), and 12.7% (95%CI, -13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (-20.5%) had greater declines in mechanical thrombectomy volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. CONCLUSION: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes.