@article{2997100,
    title = "Global impact of COVID-19 on stroke care",
    author = "Nogueira, R.G. and Abdalkader, M. and Qureshi, M.M. and Frankel, M.R. and Mansour, O.Y. and Yamagami, H. and Qiu, Z. and Farhoudi, M. and Siegler, J.E. and Yaghi, S. and Raz, E. and Sakai, N. and Ohara, N. and Piotin, M. and Mechtouff, L. and Eker, O. and Chalumeau, V. and Kleinig, T.J. and Pop, R. and Liu, J. and Winters, H.S. and Shang, X. and Vasquez, A.R. and Blasco, J. and Arenillas, J.F. and Martinez-Galdamez, M. and Brehm, A. and Psychogios, M.-N. and Lylyk, P. and Haussen, D.C. and Al-Bayati, A.R. and Mohammaden, M.H. and Fonseca, L. and Luís Silva, M. and Montalverne, F. and Renieri, L. and Mangiafico, S. and Fischer, U. and Gralla, J. and Frei, D. and Chugh, C. and Mehta, B.P. and Nagel, S. and Mohlenbruch, M. and Ortega-Gutierrez, S. and Farooqui, M. and Hassan, A.E. and Taylor, A. and Lapergue, B. and Consoli, A. and Campbell, B.C.V. and Sharma, M. and Walker, M. and Van Horn, N. and Fiehler, J. and Nguyen, H.T. and Nguyen, Q.T. and Watanabe, D. and Zhang, H. and Le, H.V. and Nguyen, V.Q. and Shah, R. and Devlin, T. and Khandelwal, P. and Linfante, I. and Izzath, W. and Lavados, P.M. and Olavarría, V.V. and Sampaio Silva, G. and de Carvalho Sousa, A.V. and Kirmani, J. and Bendszus, M. and Amano, T. and Yamamoto, R. and Doijiri, R. and Tokuda, N. and Yamada, T. and Terasaki, T. and Yazawa, Y. and Morris, J.G. and Griffin, E. and Thornton, J. and Lavoie, P. and Matouk, C. and Hill, M.D. and Demchuk, A.M. and Killer-Oberpfalzer, M. and Nahab, F. and Altschul, D. and Ramos-Pachón, A. and Pérez de la Ossa, N. and Kikano, R. and Boisseau, W. and Walker, G. and Cordina, S.M. and Puri, A. and Luisa Kuhn, A. and Gandhi, D. and Ramakrishnan, P. and Novakovic-White, R. and Chebl, A. and Kargiotis, O. and Czap, A. and Zha, A. and Masoud, H.E. and Lopez, C. and Ozretic, D. and Al-Mufti, F. and Zie, W. and Duan, Z. and Yuan, Z. and Huang, W. and Hao, Y. and Luo, J. and Kalousek, V. and Bourcier, R. and Guile, R. and Hetts, S. and Al-Jehani, H.M. and AlHazzani, A. and Sadeghi-Hokmabadi, E. and Teleb, M. and Payne, J. and Lee, J.S. and Hong, J.M. and Sohn, S.-I. and Hwang, Y.-H. and Shin, D.H. and Roh, H.G. and Edgell, R. and Khatri, R. and Smith, A. and Malik, A. and Liebeskind, D. and Herial, N. and Jabbour, P. and Magalhaes, P. and Ozdemir, A.O. and Aykac, O. and Uwatoko, T. and Dembo, T. and Shimizu, H. and Sugiura, Y. and Miyashita, F. and Fukuda, H. and Miyake, K. and Shimbo, J. and Sugimura, Y. and Beer-Furlan, A. and Joshi, K. and Catanese, L. and Abud, D.G. and Neto, O.G. and Mehrpour, M. and Al Hashmi, A. and Saqqur, M. and Mostafa, A. and Fifi, J.T. and Hussain, S. and John, S. and Gupta, R. and Sivan-Hoffmann, R. and Reznik, A. and Sani, A.F. and Geyik, S. and Akıl, E. and Churojana, A. and Ghoreishi, A. and Saadatnia, M. and Sharifipour, E. and Ma, A. and Faulder, K. and Wu, T. and Leung, L. and Malek, A. and Voetsch, B. and Wakhloo, A. and Rivera, R. and Barrientos Iman, D.M. and Pikula, A. and Lioutas, V.-A. and Thomalla, G. and Birnbaum, L. and Machi, P. and Bernava, G. and McDermott, M. and Kleindorfer, D. and Wong, K. and Patterson, M.S. and Fiorot, J.A., Jr. and Huded, V. and Mack, W. and Tenser, M. and Eskey, C. and Multani, S. and Kelly, M. and Janardhan, V. and Cornett, O. and Singh, V. and Murayama, Y. and Mokin, M. and Yang, P. and Zhang, X. and Yin, C. and Han, H. and Peng, Y. and Chen, W. and Crosa, R. and Frudit, M.E. and Pandian, J.D. and Kulkarni, A. and Yagita, Y. and Takenobu, Y. and Matsumaru, Y. and Yamada, S. and Kono, R. and Kanamaru, T. and Yamazaki, H. and Sakaguchi, M. and Todo, K. and Yamamoto, N. and Sonoda, K. and Yoshida, T. and Hashimoto, H. and Nakahara, I. and Cora, E. and Volders, D. and Ducroux, C. and Shoamanesh, A. and Ospel, J. and Kaliaev, A. and Ahmed, S. and Rashid, U. and Rebello, L.C. and Pereira, V.M. and Fahed, R. and Chen, M. and Sheth, S.A. and Palaiodimou, L. and Tsivgoulis, G. and Chandra, R. and Koyfman, F. and Leung, T. and Khosravani, H. and Dharmadhikari, S. and Frisullo, G. and Calabresi, P. and Tsiskaridze, A. and Lobjanidze, N. and Grigoryan, M. and Czlonkowska, A. and de Sousa, D.A. and Demeestere, J. and Liang, C. and Sangha, N. and Lutsep, H.L. and Ayo-Martín, Ó. and Cruz-Culebras, A. and Tran, A.D. and Young, C.Y. and Cordonnier, C. and Caparros, F. and De Lecinana, M.A. and Fuentes, B. and Yavagal, D. and Jovin, T. and Spelle, L. and Moret, J. and Khatri, P. and Zaidat, O. and Raymond, J. and Martins, S. and Nguyen, T.",
    journal = "International Journal of Stroke",
    year = "2021",
    volume = "16",
    number = "5",
    pages = "573-584",
    publisher = "SAGE Publications Inc.",
    issn = "1747-4930, 1747-4949",
    doi = "10.1177/1747493021991652",
    keywords = "acute ischemic stroke;  Article;  bleeding;  brain hemorrhage;  brain ischemia;  cerebrovascular accident;  controlled study;  coronavirus disease 2019;  hospitalization;  human;  ICD-10;  major clinical study;  mechanical thrombectomy;  observational study;  outcome assessment;  pandemic;  retrospective study;  seasonal variation;  stroke unit;  thrombectomy;  brain hemorrhage;  cerebrovascular accident;  clinical trial;  cross-sectional study;  global health;  high volume hospital;  low volume hospital;  multicenter study;  register;  time factor, COVID-19;  Cross-Sectional Studies;  Global Health;  Hospitalization;  Hospitals, High-Volume;  Hospitals, Low-Volume;  Humans;  Intracranial Hemorrhages;  Registries;  Retrospective Studies;  Stroke;  Thrombectomy;  Time Factors",
    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. © 2021 World Stroke Organization."
}