Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: A 1-Year Follow-up.

BACKGROUND AND OBJECTIVES: Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). METHODS: We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS: There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1-6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1-4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4-5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6-0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31-1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82-2.97], 5,656/195,539) of all stroke hospitalizations. DISCUSSION: There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. TRIAL REGISTRATION INFORMATION: This study is registered under NCT04934020.

Global Impact of COVID-19 on Stroke Care and IV Thrombolysis.

OBJECTIVE: 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.

Emergency Neurology Oral Cases for Trainee Assessment and Education.

OBJECTIVES: Neurological emergencies comprise much of neurology residency, but there may be a lack of clinical experience. For our program, oral examinations have been used to assess resident readiness for additional clinical independence. In this study, we examined the perceptions of learners and examiners of oral case examinations. METHODS: Six attending physicians administered case-based oral examinations to 8 trainees. Each case involved a chief complaint and progressed through a clinical encounter. Following the examination, each attending physician and trainee completed an online 5-point Likert scale survey of content and educational value. Statistical analysis of point assignment based on Likert scale responses was performed. RESULTS: Six attendings (100% response) and 7 trainees (87.5% response) completed the assessment. The trainees assessed all 6 cases. Residents had negative responses for 3 cases with specific concern in "feedback" and "learning experience." Residents responded with less positive response than attendings for "The case is easy to understand and progressed in a logical fashion" (3.90 for residents vs. 4.83 attendings; P=0.015) and "The case complexity is appropriate for level of training" (4.14 vs. 4.83; P=0.033). Attendings noted better understanding of trainees thought processes following oral examinations. Trainees noted feedback as the most useful component of case-based assessments. CONCLUSIONS: Case-based assessment in neurology training allows for rapid evaluation of trainees' abilities to critically think. There is general agreement from attendings and trainees that case-based assessment is a useful and positive learning tool. The responses from this survey are being used to modify the cases for future examinations.

Is carpal tunnel syndrome present in acute stroke patients? An investigative study using clinical and imaging screening tools.

Carpal tunnel syndrome (CTS) is known to develop post-stroke. Median nerve ultrasound (US) is an inexpensive, effective means of screening. In this prospective feasibility study, we compared the ability of the physical exam, the Boston Carpal Tunnel Questionnaire (BCTQ) and median nerve US to screen for carpal tunnel syndrome (CTS) within 72hours of stroke onset. We enrolled 24 consecutive patients. Using US, 19 (79%, p=0.0386) of the 24 patients screened positive for CTS on the paretic side and 20 (83%, p=0.0042) on the nonparetic side. With clinical examination, only 11 out of 24 (46%) screened positive for CTS on the paretic side and 8 (33%) on the nonparetic side. The BCTQ did not predict CTS. US can be an effective screening tool post-stroke. Further research is needed to determine specificity and efficacy compared to electrodiagnostic testing in this population.