Abstract P145: Who Are We Missing? False Call Rates Decline for Stroke Code Activations During Early Phase of Covid-19 Pandemic

Abstract

Introduction: To slow the spread of the novel coronavirus (COVID-19), the Department of Homeland Security restricted access across the US-Mexico border in March 2020. During the same time period hospitals throughout the US began reporting declines in emergency department (ED) visits, especially related to stroke. As a stroke receiving center and largest hospital within a Southern California border county serving a binational population, we sought to understand the impact COVID-19 and closure of an international border might have on stroke code activations (SCA) and discharges at our facility. Methods: A retrospective analysis involving 417 cases presenting to a tertiary hospital consisting of two campuses near the US-Mexico border in Southern California was performed. Inclusion criteria: all cases with SCA in the ED arriving from March 1, 2020 to June 30, 2020 and March 1, 2019 to June 30, 2019. Exclusion criteria: cases arriving to the ED that did not have SCA and cases for which stroke codes were initiated after hospitalization. Results: Pedestrian and private auto passenger border crossings decreased by over 5 million people between April and May 2020 compared to the same period in 2019. From March to June 2020, there were 162 ED SCA compared to 255 during the same period in 2019; a 36.5% decrease in SCA in 2020. Additionally, there was a significant increase in the percentage of ED SCA resulting in actual stroke discharge diagnoses during this period. In early 2020, 68.5% of ED SCA were discharged with a stroke diagnosis compared to 60.4% in 2019, X 2 (1, N = 162) = 4.467, p < .05. However, despite the increased true positive rate, there was an overall decrease in the total number of patients with SCA who were diagnosed with stroke (111 in 2020 vs 154 in 2019). Conclusion: As the overall number of SCA decreased during the early months of the COVID-19 pandemic, so did the total number of patients discharged with a stroke diagnosis. This suggests that fewer patients with acute stroke presented as a SCA during the early COVID-19 pandemic in comparison to the same time period in 2019. It is critically important as a stroke center serving a large, binational population to ensure the population we serve is seeking appropriate and timely care for serious and complex diseases.