Abstract P385: Stroke-Related Hospital Admissions During Covid-19 Pandemic in the Latin American Stroke Registry (LASE)

Background: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially acute admissions and ancillary tests availability. We assessed the impact of the pandemic and the lockdowns imposed in stroke admissions in Latin America. Methods: A multinational study (7 countries, 18 centers) of patients admitted since the pandemic outbreak (January - June 2020). These cases were compared with the same period in 2019. We also assessed patterns during the strictest lockdown period (March-June 2020). Number of cases, stroke etiology and severity, acute care and functional outcomes were compared per periods, months, centers and countries. Results: There were 1863 stroke cases in 2019 and 1781 cases in 2020 (p=0.02). We found a significant increase in strokes of undetermined etiology due to incomplete studies in 2020 [16.8% vs 27.6%, p<0.001]). Most countries reported decreases in all-type stroke admissions, except México and Brasil (16% and 36% increases in admissions, respectively). There were no significant differences among months. All-type mortality increased (6.2% vs. 12.6%, p<0.001), and poor functional outcome (mRs 3-6) increased from 32.2% to 38.8% (p=0.007) in 2020. During the period of strict lockdown (March-June 2020), ischemic stroke admissions during the first 24 hours of onset (68.3% vs. 64.4%, p=0.1) and in-hospital stroke code activation (35.1% vs. 27.6%, p=0.005) diminished compared to 2019 period. No differences in total reperfusion treatment rates were observed, with similar door-to-needle and door-to-groin times in both periods. Conclusions: All-type stroke admissions diminished only slightly during the first months of the COVID-19 pandemic. However, in this region, we found substantial deficiencies in stroke work-up, poor short-term outcome and increased mortality.

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Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era

Stroke ◽

10.1161/strokeaha.120.030481 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2315-2321 ◽

Cited By ~ 28

Author(s):

Henrique Diegoli ◽

Pedro S.C. Magalhães ◽

Sheila C.O. Martins ◽

Carla H.C. Moro ◽

Paulo H.C. França ◽

...

Keyword(s):

Hospital Admissions ◽

Statistical Tests ◽

Stroke Care ◽

Population Based ◽

Public Authorities ◽

Stroke Incidence ◽

Stroke Registry ◽

Before And After ◽

Ischemic Attack ◽

The Impact

Background and Purpose: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil. Methods: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019. Results: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 ( P =0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage. Conclusions: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.

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Development of the Madrid Stroke Programme: Milestones and Changes in Stroke Trends and Mortality from 1997 to 2017

Neuroepidemiology ◽

10.1159/000514077 ◽

2021 ◽

pp. 1-6

Author(s):

Silvia Pastor ◽

Elena de Celis ◽

Itsaso Losantos García ◽

María Alonso de Leciñana ◽

Blanca Fuentes ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Admissions ◽

Temporal Trends ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Care Organization ◽

Stroke Units ◽

Health Region ◽

Number Of Patients ◽

The Impact

Introduction: Stroke is a serious health problem, given it is the second leading cause of death and a major cause of disability in the European Union. Our study aimed to assess the impact of stroke care organization measures (such as the development of stroke units, implementation of a regional stroke code, and treatment with intravenous thrombolysis and mechanical thrombectomy) implemented from 1997 to 2017 on hospital admissions due to stroke and mortality attributed to stroke in the Madrid health region. Methods: Epidemiological data were obtained from the National Statistics Institute public website. We collected data on the number of patients discharged with a diagnosis of stroke, in-hospital mortality due to stroke and the number of inhabitants in the Madrid health region each year. We calculated rates of discharges and mortality due to stroke and the number of inhabitants per SU bed, and we analysed temporal trends in in-hospital mortality due to stroke using the Daniels test in 2 separate time periods (before and after 2011). Figures representing annual changes in these data from 1997 to 2017 were elaborated, marking stroke care organizational measures in the year they were implemented to visualize their temporal relation with changes in stroke statistics. Results: Hospital discharges with a diagnosis of stroke have increased from 170.3/100,000 inhabitants in 1997 to 230.23/100,000 inhabitants in 2017. However, the in-hospital mortality rate due to stroke has decreased (from 33.3 to 15.2%). A statistically significant temporal trend towards a decrease in the mortality percentage and rate was found from 1997 to 2011. Conclusions: Our study illustrates how measures such as the development of stroke units, implementation of a regional stroke code and treatment with intravenous thrombolysis coincide in time with a reduction in in-hospital mortality due to stroke.

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Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions

Stroke ◽

10.1161/strokeaha.120.030225 ◽

2020 ◽

Vol 51 (7) ◽

pp. 1996-2001 ◽

Cited By ~ 54

Author(s):

Jing Zhao ◽

Hang Li ◽

David Kung ◽

Marc Fisher ◽

Ying Shen ◽

...

Keyword(s):

Big Data ◽

Hospital Admissions ◽

Stroke Care ◽

Limiting Factors ◽

Limiting Factor ◽

Significant Drop ◽

The Public ◽

Key Factor ◽

Prehospital Delays ◽

The Impact

Background and Purpose: When the coronavirus disease 2019 (COVID-19) outbreak became paramount, medical care for other devastating diseases was negatively impacted. In this study, we investigated the impact of the COVID-19 outbreak on stroke care across China. Methods: Data from the Big Data Observatory Platform for Stroke of China consisting of 280 hospitals across China demonstrated a significant drop in the number of cases of thrombolysis and thrombectomy. We designed a survey to investigate the major changes during the COVID-19 outbreak and potential causes of these changes. The survey was distributed to the leaders of stroke centers in these 280 hospitals. Results: From the data of Big Data Observatory Platform for Stroke of China, the total number of thrombolysis and thrombectomy cases dropped 26.7% ( P <0.0001) and 25.3% ( P <0.0001), respectively, in February 2020 as compared with February 2019. We retrieved 227 valid complete datasets from the 280 stroke centers. Nearly 50% of these hospitals were designated hospitals for COVID-19. The capacity for stroke care was reduced in the majority of the hospitals. Most of the stroke centers stopped or reduced their efforts in stroke education for the public. Hospital admissions related to stroke dropped ≈40%; thrombolysis and thrombectomy cases dropped ≈25%, which is similar to the results from the Big Data Observatory Platform for Stroke of China as compared with the same period in 2019. Many factors contributed to the reduced admissions and prehospital delays; lack of stroke knowledge and proper transportation were significant limiting factors. Patients not coming to the hospital for fear of virus infection was also a likely key factor. Conclusions: The COVID-19 outbreak impacted stroke care significantly in China, including prehospital and in-hospital care, resulting in a significant drop in admissions, thrombolysis, and thrombectomy. Although many factors contributed, patients not coming to the hospital was probably the major limiting factor. Recommendations based on the data are provided.

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The impact of predisposing factors on long-term outcome after stroke in diabetic patients: the Fukuoka Stroke Registry

European Journal of Neurology ◽

10.1111/ene.12100 ◽

2013 ◽

Vol 20 (6) ◽

pp. 921-927 ◽

Cited By ~ 16

Author(s):

T. Kuwashiro ◽

H. Sugimori ◽

T. Ago ◽

J. Kuroda ◽

M. Kamouchi ◽

...

Keyword(s):

Predisposing Factors ◽

Diabetic Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Stroke Registry ◽

The Impact

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Reduction in Acute Stroke Admissions during the COVID-19 Pandemic: Data from a National Stroke Registry

Neuroepidemiology ◽

10.1159/000516753 ◽

2021 ◽

pp. 1-7

Author(s):

Carmit Libruder ◽

Amit Ram ◽

Yael Hershkovitz ◽

David Tanne ◽

Natan M. Bornstein ◽

...

Keyword(s):

Hospital Mortality ◽

Acute Stroke ◽

Hospital Admissions ◽

Public Awareness ◽

Length Of Hospital Stay ◽

Stroke Care ◽

Demographic Characteristics ◽

Stroke Registry ◽

Awareness Campaigns ◽

Number Of Patients

Introduction: The COVID-19 pandemic overwhelmed health-care systems worldwide, and medical care for other acute diseases was negatively impacted. We aimed to investigate the effect of the COVID-19 outbreak on admission rates and in-hospital care for acute stroke and transient ischemic attack (TIA) in Israel, shortly after the start of the pandemic. Methods: We conducted a retrospective observational study, based on data reported to the Israeli National Stroke Registry from 7 tertiary hospitals. All hospital admissions for acute stroke or TIA that occurred between January 1 and April 30, 2020 were included. Data were stratified into 2 periods according to the timing of COVID-19 restrictions as follows: (1) “pre-pandemic” – January 1 to March 7, 2020 and (2) “pandemic” – March 8 to April 30, 2020. We compared the weekly counts of hospitalizations between the 2 periods. We further investigated changes in demographic characteristics and in some key parameters of stroke care, including the percentage of reperfusion therapies performed, time from hospital arrival to brain imaging and to thrombolysis, length of hospital stay, and in-hospital mortality. Results: 2,260 cases were included: 1,469 in the pre-COVID-19 period and 791 in the COVID-19 period. Hospital admissions significantly declined between the 2 periods, by 48% for TIA (rate ratio [RR] = 0.52; 95% CI 0.43–0.64) and by 29% for stroke (RR = 0.71; 95% CI 0.64–0.78). No significant changes were detected in demographic characteristics and in most parameters of stroke management. While the percentage of reperfusion therapies performed remained unchanged, the absolute number of patients treated with reperfusion therapies seemed to decrease. Higher in-hospital mortality was observed only for hemorrhagic stroke. Conclusion: The marked decrease in admissions for acute stroke and TIA, occurring at a time of a relatively low burden of COVID-19, is of great concern. Public awareness campaigns are needed as patients reluctant to seek urgent stroke care are deprived of lifesaving procedures and secondary prevention treatments.

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The Riga East University Hospital Stroke Registry—An Analysis of 4915 Consecutive Patients with Acute Stroke

Medicina ◽

10.3390/medicina57060632 ◽

2021 ◽

Vol 57 (6) ◽

pp. 632

Author(s):

Guntis Karelis ◽

Madara Micule ◽

Evija Klavina ◽

Iveta Haritoncenko ◽

Ilga Kikule ◽

...

Keyword(s):

Risk Factors ◽

Acute Stroke ◽

Clinical Manifestations ◽

Stroke Care ◽

Registry Data ◽

University Hospital ◽

Stroke Registry ◽

Additional Information ◽

Causative Factors ◽

Undetermined Etiology

Background and Objectives: A hospital-based stroke registry is a useful tool for systematic analyses of the epidemiology, clinical characteristics, and natural course of stroke. Analyses of stroke registry data can provide information that can be used by health services to improve the quality of care for patients with this disease. Materials and Methods: Data were collected from the Riga East University Hospital (REUH) Stroke Registry in order to evaluate the etiology, risk factors, clinical manifestations, treatment, functional outcomes, and other relevant data for acute stroke during the period 2016–2020. Results: During a five-year period, 4915 patients (3039 females and 1876 males) with acute stroke were registered in the REUH Stroke Registry. The causative factors of stroke were cardioembolism (45.7%), atherosclerosis (29.9%), lacunar stroke (5.3%), stroke of undetermined etiology (1.2%), and stroke of other determined causes (1.2%). The most frequent localizations of intracerebral hemorrhage were subcortical (40.0%), lobar (18.9%), and brainstem (9.3%). The most prevalent risk factors for stroke were hypertension (88.8%), congestive heart failure (71.2%), dyslipidemia (46.7%), and atrial fibrillation (44.2%). In addition, 1018 (20.7%) patients were receiving antiplatelet drugs, 574 (11.7%) were taking statins, and 382 (7.7%) were taking anticoagulants. At discharge, 35.5% of the patients were completely independent (mRS (modified Rankin Scale) score: 0–2), while 49.5% required some form of assistance (mRS score: 3–5). The intrahospital mortality rate was 13.7%, although it was higher in the hemorrhage group (30.9%). Conclusions: Our stroke registry data are comparable to those of other major registries. Analysis of stroke registry data is important for improving stroke care and obtaining additional information for stroke studies.

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Impact of Age of Patient and Experience of Surgeon on the Outcome after Kasai Portoenterostomy: Can We Delay the Surgery?

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1713934 ◽

2020 ◽

Author(s):

Kin Wai Edwin Chan ◽

Kim Hung Lee ◽

Hei Yi Vicky Wong ◽

Siu Yan Bess Tsui ◽

Jennifer Wai Cheung Mou ◽

...

Keyword(s):

Kasai Portoenterostomy ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome ◽

Native Liver ◽

Initial Work ◽

Group A ◽

Group B ◽

The Impact ◽

Work Up

Abstract Introduction Age of patient and experience of biliary atresia (BA) center are well-known factors associated with early jaundice clearance (EJC) after Kasai portoenterostomy (KPE) in infants with BA. This study focused on the impact of age and surgeon factor on the short-term outcome after KPE within a single center. Materials and Methods Fifty-four consecutive infants (18 boys and 36 girls) who underwent KPE from January 2010 to January 2020 were reviewed. KPE was performed in the earliest available operative session once the initial work-up was completed. In group A (n = 41), KPE was performed by surgeon A. In group B (n = 13), KPE was performed by specialists under the supervision of surgeon B (who is the mentor of surgeon A) when surgeon A was not available for operation. The demographics of patients, the EJC (total bilirubin <20 μmol/L within 6 months of KPE), and 2-year native liver survival (NLS) between the two groups were studied. Results The median age at operation was 52 days (range 26–135 days). The overall EJC rate and 2-year NLS were 85.2 and 89.4%, respectively. Group A (p = 0.015) and male gender (p = 0.029) were statistically associated with EJC but not the age at operation (p = 0.101). Group A was also statistically associated with superior 2-year NLS (p = 0.047). Conclusion Balancing between the impact of age at operation and the experience of surgeon on the outcome after KPE, our result suggested that KPE may be deferred until a more experienced surgeon to operate.

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Preconditioning by Preceding Ischemic Cerebrovascular Events

Journal of the American Heart Association ◽

10.1161/jaha.120.020129 ◽

2021 ◽

Author(s):

Pamela N. Correia ◽

Ivo A. Meyer ◽

Ashraf Eskandari ◽

Michael Amiguet ◽

Lorenz Hirt ◽

...

Keyword(s):

Ischemic Stroke ◽

University Hospital ◽

Stroke Severity ◽

Term Outcome ◽

Long Term Outcome ◽

Stroke Registry ◽

Cerebral Ischemic ◽

The Impact ◽

Ischemic Events

Background Emerging yet contrasting evidence from animal and human studies associates ischemic preconditioning with improvement of subsequent stroke severity, although long‐term outcome remains unclear. The purpose of this study was to analyze how preceding cerebral ischemic events influence subsequent stroke severity and outcome. Methods and Results Data for this retrospective cohort study were extracted from ASTRAL (Acute Stroke Registry and Analysis of Lausanne). This registry includes a sample of all consecutive patients with acute ischemic strokes admitted to the stroke unit and/or intensive care unit of the Lausanne University Hospital, Switzerland. We investigated associations between preceding ischemic events (transient ischemic attacks or ischemic strokes) and the impact on subsequent stroke severity and clinical improvement within 24 hours, measured through National Institute of Health Stroke Scale, as well as 3‐month outcome, determined through a shift in the modified Rankin Scale. Of 3530 consecutive patients with ischemic stroke (43% women, median age 73 years), 1001 (28%) had ≥1 preceding cerebral ischemic events (45% transient ischemic attack, 55% ischemic stroke; 31% multiple events). After adjusting for multiple prehospital, clinical, and laboratory confounders, admission stroke severity was significantly lower in patients preconditioned through a preceding ischemic event, but 24‐hour improvement was not significant and 3‐month outcome was unfavorable. Conclusions Preceding ischemic events were independently associated with a significant reduction in subsequent stroke severity but worsened long‐term clinical outcome. These results, if confirmed by future randomized studies, may help design neuroprotective strategies. The unfavorable effect on stroke outcome is probably a consequence of the cumulative disability burden after multiple ischemic events.

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Strokes Following Attempted Suicide: Frequency, Mechanisms, Outcome and Review of the Literature

10.21203/rs.3.rs-764276/v1 ◽

2021 ◽

Author(s):

Mauro Silva ◽

Laurent Michaud ◽

Pamela Correia ◽

Masaki Nishida ◽

Patrik Michel

Keyword(s):

World Literature ◽

Early Mortality ◽

Stroke Severity ◽

Systematic Observation ◽

Term Outcome ◽

Long Term Outcome ◽

Stroke Registry ◽

Stroke Mechanism ◽

Work Up

Abstract Background: Only a few patients with strokes following suicide attempt (SFSA) are described in the literature and dissection of cervical arteries is the best-known mechanism. We aimed to determine the frequency, clinical presentation, mechanisms and outcomes of such patients by systematic observation in a single academic institution.Method: We retrospectively identified in our acute ischemic stroke registry all SFSA over 11 years. A thorough work-up was performed to establish the stroke mechanism. We also searched all published SFSA in the world literature for further analysis of demographics, comorbidities and long-term outcome. Results: Work-up showed multiple stroke mechanisms as well as multiple psychiatric. After adding 7 already published SFSA and comparing all SFSA with our stroke registry, SFSA were younger, had similar stroke severity, higher early mortality, and similar long-term functional outcome.Conclusions: SFSA is rare, affects younger patients and may be missed without an appropriate level of suspicion and neuroimaging. Long-term outcome seems comparable to other stroke patients despite an increased early mortality.

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Abstract TMP82: National Stroke Registry is Feasible and Improves Stroke Care and Training in Nigeria: A Pilot Experience

Stroke ◽

10.1161/str.48.suppl_1.tmp82 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Rufus Akinyemi ◽

Philip Adebayo ◽

Lukman Owolabi ◽

Reginald Obiako ◽

Kolawole Wahab ◽

...

Keyword(s):

Job Satisfaction ◽

Acute Stroke ◽

Stroke Care ◽

World Federation ◽

Multidisciplinary Teams ◽

Case Report Form ◽

Web Based ◽

Stroke Registry ◽

The Impact ◽

And Training

Introduction: There is data - driven evidence showing that stroke registries improve tracking, documentation and the quality of care for acute stroke patients in centres across all continents except Africa where data is lacking. We report findings from a pilot multi - centre stroke registry in Nigeria. Methods: A World Federation of Neurology/World Stroke Organization (WFN/WSO) supported stroke training programme collaborated with NIH - funded Stroke Investigative Research and Education Network (SIREN) Project to develop a web-based multicenter acute stroke registry in 13 tertiary hospitals across Nigeria. All suspected cases of stroke were recorded in a Stroke Log and CT- confirmed cases were entered into a case report form and a web-based platform (RedCAP). A one hour focus group discussion (FGD) was conducted among 7 site neurologists to evaluate the impact of the pilot programme on stroke care and training. Results: Over a 21 month period (October 2014 - June 2016), 1686 suspected cases of stroke were logged into the stroke log while 1391 brain - CT confirmed cases of stroke were logged onto RedCAP. Across all sites; mean age(SD) was 60.1 (14.2) years, 57.1% male, 78.9% had at least primary education, 67.5%, 31.0% and 1.5% had ischemic, hemorrhagic and ischemic stroke with hemorrhagic transformation respectively, 51.8% were admitted with severe stroke, hypertension was the dominant risk factor (78.7% of cases) and 21.8% died within 7 days. An FGD to evaluate impact showed improved stroke awareness, better CT rate, reduced time to CT, reduced short term mortality, improved training and competence of interns and residents, development of stroke multidisciplinary teams and better job satisfaction among site neurologists. Conclusion: A pilot multicenter national stroke registry is feasible and improves stroke care, training and neurologist job satisfaction in Nigeria.

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