Epidemiological Surveillance of the Impact of the COVID-19 Pandemic on Stroke Care Using Artificial Intelligence

• Authors: Raul Nogueira, Emory University; Jason M Davies, University at Buffalo & Gates Vascular Institute at Kaleida Health,; Rishi Gupta, Wellstar Health System, Marietta; Michael Frankel, Emory University; Ameer E Hassan, University of Texas Rio Grande Valley; Thomas Devlin, University of Tennessee Health Sciences Center; Diogo Haussen, Emory University; Mahmoud Mohammaden, Emory University; Christopher P Kellner, Mount Sinai Health System; Adam Arthur, Semmes-Murphey Clinic; Lucas Elijovich, Semmes-Murphey Clinic; Kumiko Owada, Wellstar Health System, Marietta; Dina Begun, Viz Ai Inc; Mukund Narayan, Viz Ai Inc; Nadia Mordenfeld, Viz Ai Inc; Wondwossen G Tekle, University of Texas Rio Grande Valley; Fadi Nahab, Emory University; Tudor G Jovin, Rowan University; Don Frei, Swedish Medical Center; Adnan H Siddiqui, University at Buffalo & Gates Vascular Institute at Kaleida Health; J Mocco, Mount Sinai Health System, New York
• Journal Title: STROKE
• Volume: Volume 52, Number 5
• Publisher: LIPPINCOTT WILLIAMS & WILKINS | 2021-05-01, Pages 1682-1690
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/STROKEAHA.120.031960
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Radiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Clinical Neurology; Peripheral Vascular Disease; Neurosciences & Neurology; Cardiovascular System & Cardiology; artificial intelligence; hospitalization; incidence; pandemic; perfusion

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.