@article{3102266,
    title = "Global Impact of COVID-19 on Stroke Care and IV Thrombolysis",
    author = "Nogueira, R.G. and Qureshi, M.M. and Abdalkader, M. and Martins, S.O. and Yamagami, H. and Qiu, Z. and Mansour, O.Y. and Sathya, A. and Czlonkowska, A. and Tsivgoulis, G. and Aguiar de Sousa, D. and Demeestere, J. and Mikulik, R. and Vanacker, P. and Siegler, J.E. and Kõrv, J. and Biller, J. and Liang, C.W. and Sangha, N.S. and Zha, A.M. and Czap, A.L. and Holmstedt, C.A. and Turan, T.N. and Ntaios, G. and Malhotra, K. and Tayal, A. and Loochtan, A. and Ranta, A. and Mistry, E.A. and Alexandrov, A.W. and Huang, D.Y. and Yaghi, S. and Raz, E. and Sheth, S.A. and Mohammaden, M.H. and Frankel, M. and Bila Lamou, E.G. and Aref, H.M. and Elbassiouny, A. and Hassan, F. and Menecie, T. and Mustafa, W. and Shokri, H.M. and Roushdy, T. and Sarfo, F.S. and Alabi, T.O. and Arabambi, B. and Nwazor, E.O. and Sunmonu, T.A. and Wahab, K. and Yaria, J. and Mohammed, H.H. and Adebayo, P.B. and Riahi, A.D. and Sassi, S.B. and Gwaunza, L. and Ngwende, G.W. and Sahakyan, D. and Rahman, A. and Ai, Z. and Bai, F. and Duan, Z. and Hao, Y. and Huang, W. and Li, G. and Li, W. and Liu, G. and Luo, J. and Shang, X. and Sui, Y. and Tian, L. and Wen, H. and Wu, B. and Yan, Y. and Yuan, Z. and Zhang, H. and Zhang, J. and Zhao, W. and Zi, W. and Leung, T.W. and Chugh, C. and Huded, V. and Menon, B. and Pandian, J.D. and Sylaja, P.N. and Usman, F.S. and Farhoudi, M. and Hokmabadi, E.S. and Horev, A. and Reznik, A. and Sivan Hoffmann, R. and Ohara, N. and Sakai, N. and Watanabe, D. and Yamamoto, R. and Doijiri, R. and Tokuda, N. and Yamada, T. and Terasaki, T. and Yazawa, Y. 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 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 Kondybayeva, A. and Faizullina, K. and Kamenova, S. and Zhanuzakov, M. and Baek, J.-H. and Hwang, Y. and Lee, J.S. and Lee, S.B. and Moon, J. and Park, H. and Seo, J.H. and Seo, K.-D. and Sohn, S.I. and Young, C.J. and Ahdab, R. and Wan Zaidi, W.A. and Aziz, Z.A. and Basri, H.B. and Chung, L.W. and Ibrahim, A.B. and Ibrahim, K.A. and Looi, I. and Tan, W.Y. and Yahya, N.W. and Groppa, S. and Leahu, P. and Al Hashmi, A.M. and Imam, Y.Z. and Akhtar, N. and Pineda-Franks, M.C. and Co, C.O. and Kandyba, D. and Alhazzani, A. and Al-Jehani, H. and Tham, C.H. and Mamauag, M.J. and Venketasubramanian, N. and Chen, C.-H. and Tang, S.-C. and Churojana, A. and Akil, E. and Aykaç, Ö. and Ozdemir, A.O. and Giray, S. and Hussain, S.I. and John, S. and Le Vu, H. and Tran, A.D. and Nguyen, H.H. and Nhu Pham, T. and Nguyen, T.H. and Nguyen, T.Q. and Gattringer, T. and Enzinger, C. and Killer-Oberpfalzer, M. and Bellante, F. and De Blauwe, S. and Vanhooren, G. and De Raedt, S. and Dusart, A. and Lemmens, R. and Ligot, N. and Pierre Rutgers, M. and Yperzeele, L. and Alexiev, F. and Sakelarova, T. and Bedeković, M.R. and Budincevic, H. and Cindric, I. and Hucika, Z. and Ozretic, D. and Saric, M.S. and Pfeifer, F. and Karpowic, I. and Cernik, D. and Sramek, M. and Skoda, M. and Hlavacova, H. and Klecka, L. and Koutny, M. and Vaclavik, D. and Skoda, O. and Fiksa, J. and Hanelova, K. and Nevsimalova, M. and Rezek, R. and Prochazka, P. and Krejstova, G. and Neumann, J. and Vachova, M. and Brzezanski, H. and Hlinovsky, D. and Tenora, D. and Jura, R. and Jurák, L. and Novak, J. and Novak, A. and Topinka, Z. and Fibrich, P. and Sobolova, H. and Volny, O. and Krarup Christensen, H. and Drenck, N. and Klingenberg Iversen, H. and Simonsen, C.Z. and Truelsen, T.C. and Wienecke, T. and Vibo, R. and Gross-Paju, K. and Toomsoo, T. and Antsov, K. and Caparros, F. and Cordonnier, C. and Dan, M. and Faucheux, J.-M. and Mechtouff, L. and Eker, O. and Lesaine, E. and Ondze, B. and Peres, R. and Pico, F. and Piotin, M. and Pop, R. and Rouanet, F. and Gubeladze, T. and Khinikadze, M. and Lobjanidze, N. and Tsiskaridze, A. and Nagel, S. and Ringleb, P.A. and Rosenkranz, M. and Schmidt, H. and Sedghi, A. and Siepmann, T. and Szabo, K. and Thomalla, G. and Palaiodimou, L. and Sagris, D. and Kargiotis, O. and Klivenyi, P. and Szapary, L. and Tarkanyi, G. and Adami, A. and Bandini, F. and Calabresi, P. and Frisullo, G. and Renieri, L. and Sangalli, D. and Pirson, A. and Uyttenboogaart, M. and van den Wijngaard, I. and Kristoffersen, E.S. and Brola, W. and Fudala, M. and Horoch-Lyszczarek, E. and Karlinski, M. and Kazmierski, R. and Kram, P. and Rogoziewicz, M. and Kaczorowski, R. and Luchowski, P. and Sienkiewicz-Jarosz, H. and Sobolewski, P. and Fryze, W. and Wisniewska, A. and Wiszniewska, M. and Ferreira, P. and Ferreira, P. and Fonseca, L. and Marto, J.P. and Pinho E Melo, T. and Nunes, A.P. and Rodrigues, M. and Tedim Cruz, V. and Falup-Pecurariu, C. and Krastev, G. and Mako, M. and de Leciñana, M.A. and Arenillas, J.F. and Ayo-Martin, O. and Cruz Culebras, A. and Tejedor, E.D. and Montaner, J. and Pérez-Sánchez, S. and Tola Arribas, M.A. and Rodriguez Vasquez, A. and Mayza, M. and Bernava, G. and Brehm, A. and Machi, P. and Fischer, U. and Gralla, J. and Michel, P.L. and Psychogios, M.-N. and Strambo, D. and Banerjee, S. and Krishnan, K. and Kwan, J. and Butt, A. and Catanese, L. and Demchuk, A.M. and Field, T. and Haynes, J. and Hill, M.D. and Khosravani, H. and Mackey, A. and Pikula, A. and Saposnik, G. and Scott, C.A. and Shoamanesh, A. and Shuaib, A. and Yip, S. and Barboza, M.A. and Barrientos, J.D. and Portillo Rivera, L.I. and Gongora-Rivera, F. and Novarro-Escudero, N. and Blanco, A. and Abraham, M. and Alsbrook, D. and Altschul, D. and Alvarado-Ortiz, A.J. and Bach, I. and Badruddin, A. and Barazangi, N. and Brereton, C. and Castonguay, A. and Chaturvedi, S. and Chaudry, S.A. and Choe, H. and Choi, J.H. and Dharmadhikari, S. and Desai, K. and Devlin, T.G. and Doss, V.T. and Edgell, R. and Etherton, M. and Farooqui, M. and Frei, D. and Gandhi, D. and Grigoryan, M. and Gupta, R. and Hassan, A.E. and Helenius, J. and Kaliaev, A. and Kaushal, R. and Khandelwal, P. and Khawaja, A.M. and Khoury, N.N. and Kim, B.S. and Kleindorfer, D.O. and Koyfman, F. and Lee, V.H. and Leung, L.Y. and Linares, G. and Linfante, I. and Lutsep, H.L. and Macdougall, L. and Male, S. and Malik, A.M. and Masoud, H. and McDermott, M. and Mehta, B.P. and Min, J. and Mittal, M. and Morris, J.G. and Multani, S.S. and Nahab, F. and Nalleballe, K. and Nguyen, C.B. and Novakovic-White, R. and Ortega-Gutierrez, S. and Rahangdale, R.H. and Ramakrishnan, P. and Romero, J.R. and Rost, N. and Rothstein, A. and Ruland, S. and Shah, R. and Sharma, M. and Silver, B. and Simmons, M. and Singh, A. and Starosciak, A.K. and Strasser, S.L. and Szeder, V. and Teleb, M. and Tsai, J.P. and Voetsch, B. and Balaguera, O. and Pujol Lereis, V.A. and Luraschi, A. and Almeida, M.S. and Cardoso, F.B. and Conforto, A. and De Deus Silva, L. and Varrone Giacomini, L. and Oliveira Lima, F. and Longo, A.L. and Magalhães, P.S.C. and Martins, R.T. and Mont'alverne, F. and Mora Cuervo, D.L. and Costa Rebello, L. and Valler, L. and Zetola, V.F. and Lavados, P.M. and Navia, V. and Olavarría, V.V. and Almeida Toro, J.M. and Amaya, P.F.R. and Bayona, H. and Corredor, A. and Rivera Ordonez, C.E. and Mantilla Barbosa, D.K. and Lara, O. and Patiño, M.R. and Diaz Escobar, L.F. and Dejesus Melgarejo Fariña, D.E. and Cardozo Villamayor, A. and Zelaya Zarza, A.J. and Barrientos Iman, D.M. and Rodriguez Kadota, L. and Campbell, B. and Hankey, G.J. and Hair, C. and Kleinig, T. and Ma, A. and Tomazini Martins, R. and Sahathevan, R. and Thijs, V. and Salazar, D. and Yuan-Hao Wu, T. and Haussen, D.C. and Liebeskind, D. and Yavagal, D.R. and Jovin, T.G. and Zaidat, O.O. and Nguyen, T.N. and SVIN COVID-19 Global Stroke Registry and SVIN COVID-19 Global Stroke Registry",
    journal = "Functional Neurology",
    year = "2021",
    volume = "96",
    number = "23",
    pages = "e2824-e2838",
    publisher = "NLM (Medline)",
    doi = "10.1212/WNL.0000000000011885",
    keywords = "cerebrovascular accident;  cross-sectional study;  fibrinolytic therapy;  hospitalization;  human;  pandemic;  retrospective study, COVID-19;  Cross-Sectional Studies;  Hospitalization;  Humans;  Pandemics;  Retrospective Studies;  SARS-CoV-2;  Stroke;  Thrombolytic Therapy",
    abstract = "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. © 2021 American Academy of Neurology."
}