Impact of the pandemic and concomitant COVID-19 on the management and outcomes of middle cerebral artery strokes : a nationwide registry-based study
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVES: To investigate the impact of the COVID-19 pandemic as well as concomitant COVID-19 itself on stroke care, focusing on middle cerebral artery (MCA) territory infarctions.
DESIGN: Registry-based study.
SETTING: We used the National Inpatient Sample (NIS) database, which covers a wide range of hospitals within the USA.
PARTICIPANTS: The NIS was queried for patients with MCA strokes between 2016 and 2020. In total, 35 231 patients were included.
OUTCOME MEASURES: Outcome measures were postprocedural complications, length of stays (LOSs), in-hospital mortality and non-routine discharge. Propensity score matching using all available baseline variables was performed to reduce confounders when comparing patients with and without concomitant COVID-19.
RESULTS: Mechanical thrombectomy (MT) was performed in 48.4%, intravenous thrombolysis (IVT) in 38.2%, and both MT and IVT (MT+IVT) in 13.4% of patients. A gradual increase in the use of MT and an opposite decrease in the use of IVT (p<0.001) was detected during the study period. Overall, 25.0% of all patients were admitted for MCA strokes during the pandemic period (2020), of these 209 (2.4%) were concomitantly diagnosed with COVID-19. Patients with MCA strokes and concomitant COVID-19 were significantly younger (64.9 vs 70.0; p<0.001), had significantly worse NIH Stroke Severity scores, and worse outcomes in terms of LOS (12.3 vs 8.2; p<0.001), in-hospital mortality (26.3% vs 9.8%; p<0.001) and non-routine discharge (84.2% vs 76.9%; p=0.013), as compared with those without COVID-19. After matching, only in-hospital mortality rates remained significantly higher in patients with COVID-19 (26.7% vs 8.5%; p<0.001). Additionally, patients with COVID-19 had higher rates of thromboembolic (12.3% vs 7.6%; p=0.035) and respiratory (11.3% vs 6.6%; p=0.029) complications.
CONCLUSIONS: Among patients with MCA stroke, those with concomitant COVID-19 were significantly younger and had higher stroke severity scores. They were more likely to experience thromboembolic and respiratory complications and in-hospital mortality compared with matched controls.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
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| Enthalten in: |
BMJ open - 14(2024), 2 vom: 27. Feb., Seite e080738 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ghaith, Abdul Karim [VerfasserIn] |
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| Anmerkungen: |
Date Completed 01.03.2024 Date Revised 01.03.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/bmjopen-2023-080738 |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Ghaith, Abdul Karim |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impact of the pandemic and concomitant COVID-19 on the management and outcomes of middle cerebral artery strokes |b a nationwide registry-based study |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 01.03.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVES: To investigate the impact of the COVID-19 pandemic as well as concomitant COVID-19 itself on stroke care, focusing on middle cerebral artery (MCA) territory infarctions | ||
| 520 | |a DESIGN: Registry-based study | ||
| 520 | |a SETTING: We used the National Inpatient Sample (NIS) database, which covers a wide range of hospitals within the USA | ||
| 520 | |a PARTICIPANTS: The NIS was queried for patients with MCA strokes between 2016 and 2020. In total, 35 231 patients were included | ||
| 520 | |a OUTCOME MEASURES: Outcome measures were postprocedural complications, length of stays (LOSs), in-hospital mortality and non-routine discharge. Propensity score matching using all available baseline variables was performed to reduce confounders when comparing patients with and without concomitant COVID-19 | ||
| 520 | |a RESULTS: Mechanical thrombectomy (MT) was performed in 48.4%, intravenous thrombolysis (IVT) in 38.2%, and both MT and IVT (MT+IVT) in 13.4% of patients. A gradual increase in the use of MT and an opposite decrease in the use of IVT (p<0.001) was detected during the study period. Overall, 25.0% of all patients were admitted for MCA strokes during the pandemic period (2020), of these 209 (2.4%) were concomitantly diagnosed with COVID-19. Patients with MCA strokes and concomitant COVID-19 were significantly younger (64.9 vs 70.0; p<0.001), had significantly worse NIH Stroke Severity scores, and worse outcomes in terms of LOS (12.3 vs 8.2; p<0.001), in-hospital mortality (26.3% vs 9.8%; p<0.001) and non-routine discharge (84.2% vs 76.9%; p=0.013), as compared with those without COVID-19. After matching, only in-hospital mortality rates remained significantly higher in patients with COVID-19 (26.7% vs 8.5%; p<0.001). Additionally, patients with COVID-19 had higher rates of thromboembolic (12.3% vs 7.6%; p=0.035) and respiratory (11.3% vs 6.6%; p=0.029) complications | ||
| 520 | |a CONCLUSIONS: Among patients with MCA stroke, those with concomitant COVID-19 were significantly younger and had higher stroke severity scores. They were more likely to experience thromboembolic and respiratory complications and in-hospital mortality compared with matched controls | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a neurology | |
| 650 | 4 | |a stroke | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 700 | 1 | |a El-Hajj, Victor Gabriel |e verfasserin |4 aut | |
| 700 | 1 | |a Atallah, Elias |e verfasserin |4 aut | |
| 700 | 1 | |a Rios Zermeno, Jorge |e verfasserin |4 aut | |
| 700 | 1 | |a Ravindran, Krishnan |e verfasserin |4 aut | |
| 700 | 1 | |a Gharios, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Hoang, Harry |e verfasserin |4 aut | |
| 700 | 1 | |a Bydon, Mohamad |e verfasserin |4 aut | |
| 700 | 1 | |a Ohlsson, Marcus |e verfasserin |4 aut | |
| 700 | 1 | |a Elmi-Terander, Adrian |e verfasserin |4 aut | |
| 700 | 1 | |a Tawk, Rabih G |e verfasserin |4 aut | |
| 700 | 1 | |a Jabbour, Pascal |e verfasserin |4 aut | |
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