Changes in Prehospital Stroke Care and Stroke Mimic Patterns during the COVID-19 Lockdown

Abstract

The impact of COVID-19 lockdown on prehospital stroke care is largely unknown. We aimed to compare stroke care patterns before and during a state-wide lockdown. Thus, we analysed prospective data of stroke alerts referred to our stroke centre between 1 December 2019 and 16 June 2020, and compared them between two periods—15 weeks before and 13 weeks during the state-wide lockdown declared in Lithuania on 16 March 2020. Among 719 referrals for suspected stroke, there was a decrease in stroke alerts (rate ratio 0.61, 95% CI (0.52–0.71)), stroke admissions (0.63, 95% CI (0.52–0.76)), and decrease in prehospital stroke triage quality (positive predictive value 72.1% vs. 79.9%, p = 0.042) during the lockdown. The onset-to-door time was longer (153.0 vs. 120.5 min, p = 0.049) and seizures and intracranial tumours were more common among stroke mimics (16.9% vs. 6.7%, p = 0.012 and 9.6% vs. 3.0%, p = 0.037, respectively). We conclude that there was a decline in prehospital stroke triage quality during the lockdown despite low COVID-19 incidence in the country. Moreover, we observed an increase in hospital arrival delays and severe conditions presenting as stroke mimics. Our findings suggest that improved strategies are required to maintain optimal neurological care during public health emergencies.

The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19

“…It may be attributable to the preservation of access to reperfusion therapy in the home quarantine period. This finding is in line with other centers [13] , [19] , [20] , whereas in apparent conflict with the study conducted by Briard et al [21] . In an observational cohort study, longer door-to-needle and door-to-recanalization metrics were demonstrated during the COVID-19 pandemic, partly attributed to the institution of infection control measures [21] .…”

Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis

“…Most studies compared the pandemic period (ranging from January to June 2020) to a similar period in the preceding year (range January to June 2019) [28][29][30][31]33,35,39,[41][42][43]45,46,[48][49][50]52,[54][55][56][57][58]60 or the months preceding the pandemic (range September 2019 to December 2019). 8,32,34,[36][37][38]40,44,47,51,53,59,[61][62][63]…”

“…The onset-to-door time was reported in 14/37 studies. 29,30,44,46,48,49,52,54,55,[57][58][59]61,63 There was no difference in mean onset-to-door time during pandemic when compared to pre-pandemic period (standardized mean difference=-0.2; 95% CI, -0.8 to 0.3).…”

The Impact of the Pandemic on Acute Ischaemic Stroke Endovascular Treatment from a Multidisciplinary Perspective: A Nonsystematic Review

“…This may be the result of public concern and the diversion of emergency department (ED) resources to COVID-19 patients. A prospective study in an academic stroke centre with a significant urban catchment population conducted during the COVID-19 lockdown in Vilnius, Lithuania, similarly found a decreased rate of stroke alerts and admissions, as well as a decrease in prehospital stroke triage quality and significant hospital arrival delays from symptom onset, but the timeliness of stroke care delivery in the ED was not negatively affected by the lockdown [ 7 ]. It is difficult to ascertain the exact reasons behind the successful preservation of in-hospital stroke care goals during the COVID-19 pandemic.…”

“…Advanced neuroimaging has a particularly important implication during the pandemic. Possible treatment delays due to the current crisis related to increased time intervals “onset to door” and/or “door to needle”; therefore, selection of patients for mechanical thrombectomy poses new challenges and requires refinement of established protocols [ 3 , 6 , 7 ]. Although minimising time to treatment is critical, the decision to perform mechanical thrombectomy should be individualised because current data shows that the association between endovascular reperfusion and improved functional outcome is not strictly time dependent [ 28 , 50 ].…”