• Eric Jorge García-Lamberechts, Òscar Miró, Marcos Fragiel, Pere Llorens, Sònia Jiménez, Pascual Piñera, Guillermo Burillo-Putze, Alfonso Martín, Francisco Javier Martín-Sánchez, Javier Jacob, Aitor Alquézar-Arbé, Laura Ejarque Martínez, Belén Rodríguez Miranda, Ruiz GrinspanMartínMEmergency Department, Hospital Universitario del Henares, Madrid, Spain., María Jesús Domínguez, Francisco Javier Teigell Muñoz, Sara Gayoso Martín, García GarcíaÁngelÁEmergency Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain., Marta Iglesias Vela, Virginia Carbajosa, Manuel Salido Mota, María José Marchena González, Agüera UrbanoCarmenCEmergency Department, Hospital Costa del Sol de Marbella, Málaga, Spain., Jesus Porta-Etessam, Elpidio Calvo, Juan González Del Castillo, and Spanish Investigators on Emergency Situations TeAm (SIESTA) network.
• Emergency Department, Hospital Clínico San Carlos, IDISSC, Univesidad Complutense, Madrid, Spain.
• Acad Emerg Med. 2021 Nov 1; 28 (11): 1236-1250.

ObjectiveWe investigated the incidence, predictor variables, clinical characteristics, and stroke outcomes in patients with COVID-19 seen in emergency departments (EDs) before hospitalization.MethodsWe retrospectively reviewed all COVID-19 patients diagnosed with stroke during the COVID-19 outbreak in 62 Spanish EDs. We formed two control groups: COVID-19 patients without stroke (control A) and non-COVID-19 patients with stroke (control B). We compared disease characteristics and four outcomes between cases and controls.ResultsWe identified 147 strokes in 74,814 patients with COVID-19 seen in EDs (1.96‰, 95% confidence interval [CI] = 1.66‰ to 2.31‰), being lower than in non-COVID-19 patients (6,541/1,388,879, 4.71‰, 95% CI = 4.60‰ to 4.83‰; odds ratio [OR] = 0.42, 95% CI = 0.35 to 0.49). The estimated that standardized incidences of stroke per 100,000 individuals per year were 124 and 133 for COVID-19 and non-COVID-19 individuals, respectively (OR = 0.93 for COVID patients, 95% CI = 0.87 to 0.99). Baseline characteristics associated with a higher risk of stroke in COVID-19 patients were hypertension, diabetes mellitus, and previous cerebrovascular and coronary diseases. Clinically, these patients more frequently presented with confusion, decreased consciousness, and syncope and higher D-dimer concentrations and leukocyte count at ED arrival. After adjustment for age and sex, the case group had higher hospitalization and intensive care unit (ICU) admission rates (but not mortality) than COVID-19 controls without stroke (OR = 3.41, 95% CI = 1.27 to 9.16; and OR = 3.79, 95% CI = 1.69 to 8.50, respectively) and longer hospitalization and greater in-hospital mortality than stroke controls without COVID-19 (OR = 1.55, 95% CI = 1.24 to 1.94; and OR = 1.77, 95% CI = 1.37 to 2.30, respectively).ConclusionsThe incidence of stroke in COVID-19 patients presenting to EDs was lower than that in the non-COVID-19 reference sample. COVID-19 patients with stroke had greater need for hospitalization and ICU admission than those without stroke and longer hospitalization and greater in-hospital mortality than non-COVID-19 patients with stroke.© 2021 Society for Academic Emergency Medicine.

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