Abstract P150: Effects of State Mandated Stay-At-Home Orders on Timely Presentation of Ischemic Stroke Patients During the Covid-19 Pandemic

Abstract

Introduction: The ability to treat an acute ischemic stroke depends on the patient’s timely presentation to the hospital from their last known well time. During the coronavirus disease 2019 (COVID-19) pandemic, individual state governments enacted stay-at-home orders to slow the transmission of the disease. We collected data from hospitals across four state-based networks where we provide stroke telemedicine coverage to ascertain the effects of these mandates. Objectives: We sought to evaluate the effects of stay-at-home orders on the number of patients evaluated and treated for ischemic stroke during the COVID-19 pandemic, and to evaluate the difference in treatment rate while states were under state-at-home orders versus while they were not. Methods: We retrospectively examined stroke alerts from March 1 st to May 30 th , 2020. We tabulated total number of stroke alerts, number of IV alteplase and intra-arterial (IA) treatment recommendations, number of less severe strokes (NIHSS 0-6) and more severe strokes (NIHSS 7-41). Treatment rates were calculated and compared by state-based network before, during, and after the stay-at-home orders. Results: We found that the total number of alerts per week fell by 27.33% during the stay-at-home orders across all state networks. The total number of patients treated with alteplase and total number of patients treated with IA therapy per week also dropped by 29.31% and 13.69%, respectively. The alteplase and IA treatment rate increased by 10.57% and 13.85%, respectively, during the stay-at- home orders. The percentage of total strokes considered more severe slightly increased during these orders, by 5.54%. Conclusion: During the government mandated stay-at-home orders, the total number of patients evaluated for stroke alerts decreased, as did the total number of patients treated either with alteplase or IA therapy. However, with the decrease in number treated, the rate at which patients were treated with alteplase, IA, or both, increased. The percentage of total strokes that were considered more severe slightly increased. In conclusion, while stay-at-home orders kept many stroke patients home, the most severe stroke patients continued to present to the hospital and were treated in a timely manner via telemedicine.