Impact of the 2019 Coronavirus Infectious Disease (COVID-19) pandemic on onset to door time and admissions of new onset acute ischemic stroke in a tertiary care level hospital in North India.

Abstract

ABSTRACTContext:Coronavirus infectious disease (COVID-19) pandemic disrupted the already marginalized healthcare provision in resource limited countries like India.Aims:This study compared onset to door time and temporal trends of admissions to seek medical care in new onset acute ischaemic stroke during the COVID-19 period with a representative pre-COVID-19 period in rural background.Settings and Design:Prospective Cross-sectional study in a tertiary level hospital in North India.Methods and Material:Study included new onset acute ischaemic stroke admitted within first 2 weeks of symptoms onset. Subjects were divided into: Group A – Pre-COVID-19 stroke, Group B – Non-COVID-19 Stroke, and Group C - Stroke, positive for COVID-19. Detailed epidemiological, clinical profile, onset to door time and temporal trends of admissions were recorded.Statistical Analysis Used:Chi square/Fisher’s exact test and Independent Samples T test or Mann–Whitney U test were used for categorical and continuous variables.Results:Onset to door time in new onset acute ischaemic stroke was significantly prolonged by 6 h in COVID-19 period (median (interquartile range), 19 (12–27) h) as compared with pre-COVID-19 period. Admissions of new onset acute ischaemic stroke were significantly less in COVID-19 period. Comorbidities and severity of stroke (mean National Institutes of Health Stroke Scale, 20 ± 4) were more during the COVID-19 period. Incidence and mortality of COVID-19 positive new onset acute ischaemic stroke were 0.95% and 38%.Conclusions:Onset to door time in new onset acute ischaemic stroke was significantly prolonged in COVID-19 as compared with pre-COVID-19 period. The admissions were fewer with more severity and comorbidities in COVID-19 period. COVID-19 positive stroke patients had more severity and mortality as compared with non-COVID-19 stroke.