Impact of COVID-19 on Acute Stroke Presentation at a Comprehensive Stroke Center

Abstract

Background: COVID-19 has impacted healthcare in many ways, including presentation of acute stroke. Since time-sensitive thrombolysis is essential for reducing morbidity and mortality in acute stroke, any delays due to the pandemic can have serious consequences. Methods: We retrospectively reviewed the electronic medical records for patients presenting with acute ischemic stroke at a comprehensive stroke center in March-April 2020 (the early months of COVID-19) and compared to the same time period in 2019. Stroke metrics such as incidence, time to arrival, and immediate outcomes were assessed. Results: There were 48 acute ischemic strokes (of which 7 were transfers) in March-April 2020 compared to 64 (of which 12 were transfers) in 2019. The average last known well to arrival time (±SD) for stroke codes was 1,041 (±1682.1) min in 2020 and 554 (±604.9) min in 2019. Of the patients presenting directly to the ED with a known last known well time, 27.8% (10/36) presented in the first 4.5 h in 2020, in contrast to 40.5% (15/37) in 2019. Patients who died comprised 10.4% of the stroke cohort in 2020 (5/48) compared to 6.3% in 2019 (4/64). Conclusions: During the first 2 months of COVID-19, there were fewer overall stroke cases who presented to our hospital, and of these cases, there was delayed presentation in comparison to the same time period in 2019. Recognizing how stroke presentation may be affected by COVID-19 would allow for optimization of established stroke triage algorithms in order to ensure safe and timely delivery of stroke care during a pandemic.

A meta‐analysis of the global impact of the COVID‐19 pandemic on stroke care & the Houston Experience

“…A total of 52 studies reporting the impact of the COVID‐19 pandemic on stroke admissions were identified for qualitative synthesis. A total of 32,640 stroke admissions from 29 studies 6‐34 were included in the meta‐analysis (Figure 1) (Supplementary Table S1) based on a similar time frame of the study period and comparison period, of which ratios were derived, depending on each criterion data availability. Compared to the prepandemic period, the mean ratio of stroke admissions during the pandemic was 70.78% [95% CI: (65.02%, 76.54%)] (Figure 2) and the mean ratio of ICH cases was 83.10% [95% CI: (71.01%, 95.17%)] (Supplementary Figure S1).…”

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

“… 163 , 244 In addition, due to fears of contracting SARS-CoV-2, many patients fail to seek prompt medical attention in emergent and urgent situations. 245 , 246 A report from Malaysia found a 65.4% decline in hospitalizations in patients with SLE during the lockdown period compared to 2019 rates. However, the patients with SLE who presented to the hospital in 2020 were significantly sicker when compared to those admitted in 2019 with respect to Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), intensive care unit requirement, and mortality.…”

Investigating the effects of the COVID-19 pandemic on the reasons for application to the emergency department in patients with neurological symptoms

“…The important issue is the question of whether there is a decrease in the number of patients with neurological diseases that can be fatal and require rapid treatment, such as stroke. In various studies, it has been reported that the number of cases with severe neurological disease (such as acute stroke) decreased after the pandemic, and there were delays in the application/admission of patients with acute stroke [ 12 – 15 ].…”