Abstract
Introduction: A decline in suspected acute stroke (“code stroke”) presentations in the United States (US) during the first COVID surge has been previously reported. While state emergency declarations may have contributed to the decline and rebound of weekly code stroke activations in our region, the exact temporal relationship of those declarations relative to weekly code stroke volumes is unclear. Methods: We conducted an interrupted time series analysis (ITSA) to identify the impact of the first reported COVID case in North Carolina (NC) and subsequent statewide executive orders (SEOs) on weekly code stroke activation trends across our regional stroke network’s 20 facilities during a 33-week period (December 8, 2019 to July 25, 2020). We included the following time epochs: the first reported COVID case in NC, the NC SEO prohibiting mass gatherings and closing public schools, the stay-at-home NC SEO, and the NC phase 1 and phase 2 reentry orders, which eased restrictions. Results: Utilizing our integrated healthcare network’s code stroke registry, we evaluated 3740 code stroke activations over a 33-week period. We performed two ITSA considering different starting points for the first intervention—one defined as the first COVID case and the other the first SEO. For both models the end of the first-time interval ended with the second SEO. Most of the downward trend in code stroke activation volume was temporally after the first COVID case (p=0.0029), not after the first SEO. After the second SEO, which increased social restrictions, there was a significant increased trend in code stroke activation volume (p=0.0047), while the phase 1 and 2 reopening SEOs were not associated with a significant increase in weekly code stroke activations. Conclusion: Our data indicate that in our region, the decreased trend in code stroke activations preceded the first SEO and started temporally after the first reported COVID case in NC. The overall decrease in code stroke volume was not significantly associated with increasing statewide restrictions and lessening of those restrictions was not significantly associated with a rebounding trend. Restrictive and reentry SEOs do not explain changes in weekly code stroke activation trends our region experienced during its first COVID surge.
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