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Published on: May 22, 2019
COVID-19 Impact on Stroke Presentations
Sheryl Strasser1, Laszlo Miskolczi1, John Cunha1
1Phil Smith Neuroscience Center, Holy Cross Hospital, 4725 N Federal Hwy, Ft Lauderdale, FL 33308.
Insights
The COVID-19 pandemic led to fewer emergency department visits for stroke, but an increase in younger patients experiencing large-vessel occlusions requiring intervention. Further research is needed to understand these unique stroke presentations.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic caused a significant decrease in hospital emergency department visits.
- Hospitals observed a subsequent rise in young individuals presenting with large-vessel occlusions (LVOs).
- This study aimed to identify novel stroke trends during the pandemic.
Purpose of the Study:
- To analyze stroke patient data during the COVID-19 pandemic.
- To investigate changes in stroke presentation and patient demographics.
- To compare findings with existing literature on pandemic-related stroke trends.
Main Methods:
- Retrospective review of patient database at a Thrombectomy Stroke Center.
- Analysis of emergency department visits, stroke alerts, and stroke admissions.
- Examination of patient demographics, including age and eligibility for tissue plasminogen activator (tPA).
Main Results:
- Emergency department visits and stroke alerts decreased significantly during the early pandemic months.
- Despite overall lower stroke presentations, the number of patients eligible for tPA doubled unexpectedly.
- A notable increase in younger patients (≤60 years old) requiring acute intervention for LVOs was observed, which was unusual for the center's demographic profile.
Conclusions:
- COVID-19 has been associated with unique stroke presentations, even in lower-risk populations.
- Understanding the mechanisms behind these changes is crucial for effective stroke prevention.
- Timely acute interventions must be maintained despite evolving stroke patterns.
Background:
As Covid-19 evolved into a world-wide pandemic, hospitals reported marked declines in strokes, only to be followed by reports of increased numbers of young people presenting with large-vessel occlusions. We reviewed our patient data-base to determine if similar or other novel trends were present.
Results:
Our Thrombectomy Stroke Center experienced marked declines in ED visits from 2,349 in early March to 1,178 in late April, stroke alerts dropped from 34 to 14 during the same period. Average monthly stroke admissions dropped from 34 in 2019 to 23 in 2020. Nonetheless, in March, we had 12 patients eligible for tPA, which is twice the typical caseload and was unexpected given the low overall stroke presentations. Although the neurointervention caseload was low, the patients were significantly younger. Of the acute intervention patients in March, 5 of the 12 patients were ≤ 60 years old, and two were in their 30's. These trends are similar to those reported elsewhere but were highly unusual for our center as our catchment area is predominantly Caucasian with 34 % of the population > 65 years of age.
Conclusions:
Even in low risk centers Covid-19 will likely impart unique stroke presentations. It will be imperative to determine the mechanisms responsible for these changes so we can institute effective strategies for optimal stroke prevention as well as maintain timely acute interventions.
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