Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza

  1. Alexander E. Merkler
  2. Neal S. Parikh
  3. Saad Mir
  4. Ajay Gupta
  5. Hooman Kamel
  6. Eaton Lin
  7. Joshua Lantos
  8. Edward J. Schenck
  9. Parag Goyal
  10. Samuel S. Bruce
  11. Joshua Kahan
  12. Kelsey N. Lansdale
  13. Natalie M. LeMoss
  14. Santosh B. Murthy
  15. Philip E. Stieg
  16. Matthew E. Fink
  17. Costantino Iadecola
  18. Alan Z. Segal
  19. Marika Cusick
  20. Thomas R. Campion
  21. Ivan Diaz
  22. Cenai Zhang
  23. Babak B. Navi

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Abstract

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  1. Version published to 10.1001/jamaneurol.2020.2730
  2. ScreenIT

    SciScore for 10.1101/2020.05.18.20105494: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Our Institutional Review Board approved this study and waived the requirement for informed consent.
    Consent: Our Institutional Review Board approved this study and waived the requirement for informed consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, we may have underestimated the true rate of ischemic stroke in patients hospitalized with Covid-19 infection because these patients are sometimes too unstable to undergo brain imaging. In addition, some patients with undiagnosed Covid-19 and stroke may have died before reaching the hospital. Conversely, the recent surge in Covid-19 in New York City could have affected the threshold for visiting the ED or hospitalization and therefore it is possible that patients who sought emergency care with Covid-19 in our cohort were more severely ill than patients who sought emergency care with influenza in past years. The increased risk of stroke in Covid-19 infection may thus reflect greater severity of underlying illness. Second, our study involved two hospitals and thus our results may not be generalizable to other settings. In particular, we were unable to estimate the population-level incidence of ischemic stroke among patients infected with SARS-CoV-2 and compare this incidence to the general population. In conclusion, the proportion of patients with ED visits and hospitalizations with Covid-19 who had acute ischemic stroke was approximately 7.5-fold higher than the proportion seen in patients who visited the ED or were hospitalized with influenza.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.05.18.20105494v1 on medRxiv