Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

Abstract

Introduction The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. Methods This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). Results There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. Conclusions During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.

Impact of National Lockdown on the Hyperacute Stroke Care and Rapid Transient Ischaemic Attack Outpatient Service in a Comprehensive Tertiary Stroke Centre During the COVID-19 Pandemic

“…This could probably explain the longer delay in symptom onset-to-door time and onset to needle time in stroke patients and consequently the reduced proportion of patients who presented within the therapeutic time window for thrombolysis during the COVID pandemic. Interestingly, we did not observe any significant delay to reperfusion (door-to-needle and groin-to-puncture time) for IVT and EVT, in line with other centers worldwide ( 11 , 13 , 22 , 27 , 30 – 32 ) and with our preliminary report ( 47 ). By contrast Meza et al ( 6 ) and Briard et al ( 7 ) reported an increment in their door-to-needle time likely secondary to their new in-hospital infection control measures to manage stroke patients with suspected COVID-19 that may have delayed the acute stroke management.…”

“…In addition, our study showed that the proportion of patients with previous history of dementia, admitted to our HASU or assessed in our rapid outpatient TIA clinic, was statistically significantly lower during the COVID-19 outbreak compared to the same period in 2019. Several centers have described significant difference in severity at presentation of stroke patients but to date no difference in the degree of pre-stroke disability or dependence in the daily activities has been reported ( 11 , 30 , 32 ). Based on the available data, poor pre-admission functional status and dementia are risk factors for in-hospital mortality in patients with COVID-19 ( 42 ).…”

Impact of COVID-19 on the Speech and Language Therapy Profession and Their Patients

“…One explanation could be that it is simply not safe for SLTs to deliver care to these groups in the COVID-19 context ( 39 ), or these patient groups may be less able to rapidly adapt or adhere to tele-therapy ( 40 ), leading to less engagement in this period. However, the reduction observed in stroke cases from SLTs is in line with other reports showing a concerning reduction in stroke admissions across the UK throughout the lockdown period ( 41 ). Similarly, the data shows a reduction in episodes of care for dementia patients, but relatively consistent representation of patients with Motor Neuron Disease (Amyotrophic Lateral Sclerosis), Parkinson's disease and those with brain tumors.…”

Stroke admission rates before, during and after the first phase of the COVID-19 pandemic

“…Many stroke centres have reported that COVID-19 discourages patients from contacting the health care system with an increase in prehospital delay and decrease in stroke admissions as a result [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. We have previously reported a decrease of almost 1/3 in stroke admissions in relation to the lockdown in Norway [6].…”

“…On the contrary, health authorities emphasised that suspected stroke victims should continue to seek medical attention and call the emergency medical services despite the lockdown. There are contradicting results regarding prehospital delay and the overall number and proportion of ischemic stroke patients receiving intravenous thrombolysis during the lockdown [1,2,5,7,8,[10][11][12][13] and reduced standard of care and delayed stroke care pathways with increased door-to-needle time have also been reported [1,2,5,7,8,[10][11][12][13]. The proportion receiving thrombolysis if they reached our hospital within the time window was similar for all three periods, indicating that the hospital's acute stroke workflow and pathway were not affected to a degree harming patients [10,20].…”