Abstract
The impact of COVID-19 lockdown on prehospital stroke care is largely unknown. We aimed to compare stroke care patterns before and during a state-wide lockdown. Thus, we analysed prospective data of stroke alerts referred to our stroke centre between 1 December 2019 and 16 June 2020, and compared them between two periods—15 weeks before and 13 weeks during the state-wide lockdown declared in Lithuania on 16 March 2020. Among 719 referrals for suspected stroke, there was a decrease in stroke alerts (rate ratio 0.61, 95% CI (0.52–0.71)), stroke admissions (0.63, 95% CI (0.52–0.76)), and decrease in prehospital stroke triage quality (positive predictive value 72.1% vs. 79.9%, p = 0.042) during the lockdown. The onset-to-door time was longer (153.0 vs. 120.5 min, p = 0.049) and seizures and intracranial tumours were more common among stroke mimics (16.9% vs. 6.7%, p = 0.012 and 9.6% vs. 3.0%, p = 0.037, respectively). We conclude that there was a decline in prehospital stroke triage quality during the lockdown despite low COVID-19 incidence in the country. Moreover, we observed an increase in hospital arrival delays and severe conditions presenting as stroke mimics. Our findings suggest that improved strategies are required to maintain optimal neurological care during public health emergencies.
Highlights
Emergency medical services (EMS) are the first healthcare contact for most stroke patients [1,2] and play a crucial role in identifying acute stroke [3]
719 patients with suspected stroke were included in our analysis: 493 referred by EMS and 226 by outpatient physicians (Figure 2)
Public Health 2021, 18, 2150 cantly in sex and age, regardless of being referred by EMS or a physician (Table4 of1).11None of the patients were diagnosed with COVID-19
Summary
Emergency medical services (EMS) are the first healthcare contact for most stroke patients [1,2] and play a crucial role in identifying acute stroke [3]. Accurate recognition and timely transport of patients with suspected stroke to comprehensive stroke centres (CSCs) are closely correlated with acute stroke care success [2,4]. Other disorders may have similar clinical presentations. These false positives, called stroke mimics, comprise from 15% to 37% of suspected stroke patients at the Emergency Department (ED) [6,7]. The consequences of stroke mimics may result in inappropriate usage of stroke care facilities and medical resources and increased workload on overwhelmed ED personnel [6,8]. A decreasing number of stroke admissions observed during the ongoing severe acute respiratory coronavirus 2 (SARS-CoV-2) outbreak causing
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