Raul G Nogueira1, Jason M Davies2, Rishi Gupta3, Ameer E Hassan4, Thomas Devlin5, Diogo C Haussen1, Mahmoud H Mohammaden1, Christopher P Kellner6, Adam Arthur7, Lucas Elijovich7, Kumiko Owada3, Dina Begun8, Mukund Narayan8, Nadia Mordenfeld8, Wondwossen G Tekle4, Fadi Nahab9, Tudor G Jovin10, Don Frei11, Adnan H Siddiqui2, Michael R Frankel1, J Mocco6. 1. Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory School of Medicine, Atlanta, GA (R.G.N., D.C.H., M.H.M., M.R.F.). 2. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo & Gates Vascular Institute at Kaleida Health, New York (J.M.D., A.H.S.). 3. Wellstar Medical Group Neurosurgery (RG) and Neurosciences (KO), Wellstar Health System, Marietta, GA (R.G., K.O.). 4. University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.). 5. Erlanger Health System, University of Tennessee Health Sciences Center, Chattanooga, TN (T.D.). 6. Department of Neurosurgery, Mount Sinai Health System, New York (C.P.K., J.M.). 7. Department of Neurosurgery (AA) and Neurology (LE), Semmes-Murphey Clinic and University of Tennessee Health Sciences Center, Memphis (A.A., L.E.). 8. Viz.ai, Inc, Palo Alto, CA (D.B., M.N., N.M.). 9. Department of Neurology and Pediatrics, Emory University, Atlanta, GA (F.N.). 10. Cooper University Hospital, Neurological Institute and Cooper Medical School of Rowan University, Camden, NJ (T.G.J.). 11. Radiology Imaging Associates/RIA Neurovascular, Swedish Medical Center, Denver, CO (D.F.).
Abstract
BACKGROUND AND PURPOSE: The degree to which the coronavirus disease 2019 (COVID-19) pandemic has affected systems of care, in particular, those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial intelligence platform. METHODS: Data were derived from the Viz Platform, an artificial intelligence application designed to optimize the workflow of patients with acute stroke. Neuroimaging data on suspected patients with stroke across 97 hospitals in 20 US states were collected in real time and retrospectively analyzed with the number of patients undergoing imaging screening serving as a surrogate for the amount of stroke care. The main outcome measures were the number of computed tomography (CT) angiography, CT perfusion, large vessel occlusions (defined according to the automated software detection), and severe strokes on CT perfusion (defined as those with hypoperfusion volumes >70 mL) normalized as number of patients per day per hospital. Data from the prepandemic (November 4, 2019 to February 29, 2020) and pandemic (March 1 to May 10, 2020) periods were compared at national and state levels. Correlations were made between the inter-period changes in imaging screening, stroke hospitalizations, and thrombectomy procedures using state-specific sampling. RESULTS: A total of 23 223 patients were included. The incidence of large vessel occlusion on CT angiography and severe strokes on CT perfusion were 11.2% (n=2602) and 14.7% (n=1229/8328), respectively. There were significant declines in the overall number of CT angiographies (-22.8%; 1.39-1.07 patients/day per hospital, P<0.001) and CT perfusion (-26.1%; 0.50-0.37 patients/day per hospital, P<0.001) as well as in the incidence of large vessel occlusion (-17.1%; 0.15-0.13 patients/day per hospital, P<0.001) and severe strokes on CT perfusion (-16.7%; 0.12-0.10 patients/day per hospital, P<0.005). The sampled cohort showed similar declines in the rates of large vessel occlusions versus thrombectomy (18.8% versus 19.5%, P=0.9) and comprehensive stroke center hospitalizations (18.8% versus 11.0%, P=0.4). CONCLUSIONS: A significant decline in stroke imaging screening has occurred during the COVID-19 pandemic. This analysis underscores the broader application of artificial intelligence neuroimaging platforms for the real-time monitoring of stroke systems of care.
BACKGROUND AND PURPOSE: The degree to which the coronavirus disease 2019 (COVID-19) pandemic has affected systems of care, in particular, those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial intelligence platform. METHODS: Data were derived from the Viz Platform, an artificial intelligence application designed to optimize the workflow of patients with acute stroke. Neuroimaging data on suspected patients with stroke across 97 hospitals in 20 US states were collected in real time and retrospectively analyzed with the number of patients undergoing imaging screening serving as a surrogate for the amount of stroke care. The main outcome measures were the number of computed tomography (CT) angiography, CT perfusion, large vessel occlusions (defined according to the automated software detection), and severe strokes on CT perfusion (defined as those with hypoperfusion volumes >70 mL) normalized as number of patients per day per hospital. Data from the prepandemic (November 4, 2019 to February 29, 2020) and pandemic (March 1 to May 10, 2020) periods were compared at national and state levels. Correlations were made between the inter-period changes in imaging screening, stroke hospitalizations, and thrombectomy procedures using state-specific sampling. RESULTS: A total of 23 223 patients were included. The incidence of large vessel occlusion on CT angiography and severe strokes on CT perfusion were 11.2% (n=2602) and 14.7% (n=1229/8328), respectively. There were significant declines in the overall number of CT angiographies (-22.8%; 1.39-1.07 patients/day per hospital, P<0.001) and CT perfusion (-26.1%; 0.50-0.37 patients/day per hospital, P<0.001) as well as in the incidence of large vessel occlusion (-17.1%; 0.15-0.13 patients/day per hospital, P<0.001) and severe strokes on CT perfusion (-16.7%; 0.12-0.10 patients/day per hospital, P<0.005). The sampled cohort showed similar declines in the rates of large vessel occlusions versus thrombectomy (18.8% versus 19.5%, P=0.9) and comprehensive stroke center hospitalizations (18.8% versus 11.0%, P=0.4). CONCLUSIONS: A significant decline in stroke imaging screening has occurred during the COVID-19 pandemic. This analysis underscores the broader application of artificial intelligence neuroimaging platforms for the real-time monitoring of stroke systems of care.
Authors: Pablo Ormeño; Gastón Márquez; Camilo Guerrero-Nancuante; Carla Taramasco Journal: Int J Environ Res Public Health Date: 2022-06-30 Impact factor: 4.614