COVID-19 Pandemic Impact on Care for Stroke in Australia: Emerging Evidence From the Australian Stroke Clinical Registry.

Dominique A Cadilhac ,Natasha A Lannin,Brett Jones,Timothy Kleinig,Kelvin Hill,Rohan Grimley,Katherine Jaques,Joosup Kim,Helen Castley,Craig S Anderson,Emma K Tod,Susan Hillier,Bernard Yan,Sandy Middleton,Peter Mitchell ,Richard I Lindley ,Steven Faux ,B Clissold ,Sibilah Breen ,Julie Morrison ,Geoffrey Cloud ,Bruce Campbell

doi:10.3389/fneur.2021.621495

Abstract

We present information on acute stroke care for the first wave of the COVID-19 pandemic in Australia using data from the Australian Stroke Clinical Registry (AuSCR). The first case of COVID-19 in Australia was recorded in late January 2020 and national restrictions to control the virus commenced in March. To account for seasonal effects of stroke admissions, patient-level data from the registry from January to June 2020 were compared to the same period in 2019 (historical-control) from 61 public hospitals. We compared periods using descriptive statistics and performed interrupted time series analyses. Perceptions of stroke clinicians were obtained from 53/72 (74%) hospitals participating in the AuSCR (80% nurses) via a voluntary, electronic feedback survey. Survey data were summarized to provide contextual information for the registry-based analysis. Data from the registry covered locations that had 91% of Australian COVID-19 cases to the end of June 2020. For the historical-control period, 9,308 episodes of care were compared with the pandemic period (8,992 episodes). Patient characteristics were similar for each cohort (median age: 75 years; 56% male; ischemic stroke 69%). Treatment in stroke units decreased progressively during the pandemic period (control: 76% pandemic: 70%, p < 0.001). Clinical staff reported fewer resources available for stroke including 10% reporting reduced stroke unit beds. Several time-based metrics were unchanged whereas door-to-needle times were longer during the peak pandemic period (March-April, 2020; 82 min, control: 74 min, p = 0.012). Our data emphasize the need to maintain appropriate acute stroke care during times of national emergency such as pandemic management.

Highlights

Stroke is a time critical emergency and is a leading cause of death and disability
The aim of this paper is to describe the impact of the COVID19 pandemic on stroke services from the perspective of hospitals participating in the Australian Stroke Clinical Registry (AuSCR) up until the end of June 2020
Compared to the pre-pandemic period, more patients arrived to hospital by ambulance in March–April 2020 (p < 0.001) and May–June (p = 0.001) and there was a shorter time between hospital arrival and brain scan (p < 0.001 and p = 0.041, respectively)

Summary

Introduction

Stroke is a time critical emergency and is a leading cause of death and disability. Better outcomes are achievable with early presentation to hospital and treatment in a specialized stroke unit [1]. There have been reports that the Coronavirus Disease 2019 (COVID-19) pandemic has impacted presentations to hospital and the ability to provide the same standard of acute stroke care as prior to the pandemic. During this time, national organizations for stroke have issued statements to encourage people with suspected stroke to avoid delays in seeking medical attention and to promote and preserve best practice management in hospitals [2]. The impacts on emergency department presentations and admissions to hospitals for acute stroke during the COVID19 pandemic have been reported [3,4,5,6,7,8,9,10,11,12,13]. Provision of reperfusion treatments and the timeliness of these have decreased or remained stable [3, 5, 6, 8, 12, 17, 18]

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Conclusion