Abstract

Introduction The World Health Organization declared COVID-19 a global pandemic last year. While a clear impact of COVID-19 on the declining stroke volume has been reported, its overall impact on stroke presentation and clinical outcomes has not been established. The purpose of this study was to assess the impact of COVID-19 on acute ischemic stroke volume, presentation, treatment, and outcomes at comprehensive stroke centers. Methods A retrospective review of patients with a discharge diagnosis of acute ischemic stroke from the Get With The Guidelines database was performed from January 1, 2019, to July 1, 2020. The following time periods were defined: Pre-COVID (January/February), Peak-COVID (March/April), and Post-COVID (May/June). Bivariate analyses were performed comparing the 2020 and 2019 time periods to determine differences in stroke volume, presentation, treatment, and outcomes. Results Stroke volumes were significantly lower during the Peak-COVID period in 2020 compared to that in 2019, with an absolute decline of 49.5% (P < 0.001). Patients were more likely to present after 24 hours from last known well during the 2020 Peak-COVID period (P = 0.03). However, there was not a significant difference in the rate of treatment with either the tissue plasminogen activator (tPA) or mechanical thrombectomy during the Peak-COVID period. Interestingly, relative treatment rates increased during the 2020 Post-COVID period to 11.4% (P = 0.01). Conclusions The overall ischemic stroke volume decreased during the pandemic, and patients had a tendency to present later, beyond eligible treatment windows. However, rates of treatment, patient demographics, and stroke outcomes did not significantly change when compared to the prior year.

Highlights

  • The World Health Organization declared COVID-19 a global pandemic last year

  • There were 100 patients who presented with acute ischemic stroke during the 2020 Peak-COVID time period compared to 198 stroke patients in 2019, representing almost half (50.5%) of the stroke volume

  • Stroke volume decreased in 2020 during the COVID-19 pandemic, stroke patients that presented for medical care had similar characteristics of age, sex, National Institute of Health Stroke Scale (NIHSS), and mode of arrival as in the previous year

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Summary

Introduction

The World Health Organization declared COVID-19 a global pandemic last year. While a clear impact of COVID-19 on the declining stroke volume has been reported, its overall impact on stroke presentation and clinical outcomes has not been established. Bivariate analyses were performed comparing the 2020 and 2019 time periods to determine differences in stroke volume, presentation, treatment, and outcomes. Stroke volumes were significantly lower during the Peak-COVID period in 2020 compared to that in 2019, with an absolute decline of 49.5% (P < 0:001). The overall ischemic stroke volume decreased during the pandemic, and patients had a tendency to present later, beyond eligible treatment windows. Rates of treatment, patient demographics, and stroke outcomes did not significantly change when compared to the prior year. Hospitals and surgical departments around the world were forced to restructure the way that healthcare is delivered This was true when it came to the delivery of emergency care for stroke and cerebrovascular diseases. Due to the fear of the pandemic and overwhelmed healthcare systems, patients with stroke and cerebrovascular disease may have been extremely hesitant to seek emergency hospital care, especially if it were not a life-threatening symptom [12]

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