ABSTRACT
Background and aims: We aim at describing the impact of the first, second and third waves of the COVID-19 pandemic on stroke services in Tuscany. We measured the global impact of the COVID-19 pandemic on the volumes of both intracranial hemmorhage (ICH) and acute ischemic stroke (AIS) hospitalizations, as well as of reperfusion treatments throughout the pandemic years 2020-21 (January1, 2020 -June 30, 2021) compared with the year 2019 control period. Methods: Retrospective, observational, multicenter study, across 3 huband- spoke stroke systems, and 22 stroke hospitals. The diagnoses were identified by their ICD-9 CM codes and/or classifications in stroke databases at participating centers. Results: In comparison with the same periods of 2019, the hospitalization volumes for ICHs and for AIS declined by 26% and 30.1% respectively during the fist pandemic wave, by 11% and 24.6% during the second wave, and by 2.5% and 4% during the third wave. Reperfusion treatments decreased by 15% during the first wave, and by 11.4% and 0.3% during the second and third waves respectively. Treated patients' functional outcome at 90days did not vary throughout the pandemic waves. Casefatality at 30days increased from 10.3% to 10.8% for AIS, and from 26.5% to 27.6% for ICH before and after the COVID-19 outbreak. Conclusions: The COVID-19 pandemic waves were associated with a decreasing decline in the volume of stroke hospitalizations, nevertheless fewer and probably the most severe patients were able to reach the hospital within the therapeutic windows. We observed different pattern of variations across the three hub-and-spoke systems.