ABSTRACT
Introduction: We assessed the impact of COVID-19 pandemic on stroke admissions and care metrics within a health system of 10 stroke centers, with 4 comprehensive stroke centers (CSC) in the greater Houston region. Methods: Between January-June 2019 and January-June 2020, we compared the proportion of ischemic strokes (total & direct CSC presentations) & intracerebral hemorrhage (ICH) relative to total admissions using logistic regression, and among the direct CSC presentations, we compared door to tPA and thrombectomy times using Wilcoxon Rank Sum. Results: A total of 4808 cases were assessed (Table 1). There was an initial drop of ∼30% in cases at the pandemic onset (Fig.1). Numerically fewer patients in the 2020 period were seen at primary and CSCs (Table 1). Compared to 2019, there was a significant reduction in transferred patients [N(%), 829 (36) vs. 637 (34), p=0.02], in hospital strokes [N(%), 111 (5) vs. 69 (4), p=0.04], and mild strokes (NIHSS 1-5) [N (%), 891 (43) vs. 635 (40),p=0.02], and no significant differences in the proportions of total ischemic strokes [OR (95% CI)=0.92 (0.79, 1.06), p=0.23], direct CSC presentations [OR (95% CI) =0.96 (0.86, 1.08), p=0.48] and ICH [OR (95% CI) =1.14 (0.98, 1.33), p=0.08] in 2020 (Fig. 1). Among the direct ischemic strokes at CSCs, there were similar mean (SD) (mins) door to tPA [44 (17) vs. 42 (17), p=0.14] but significantly prolonged door to thrombectomy times [94 (15) vs. 85 (20), p=0.005] in 2020. Conclusion: COVID-19 pandemic led to reduced mild stroke admissions, transfers and in hospital stroke alerts, & prolonged door to thrombectomy times. Identifying reasons to mitigate this discrepancy is crucial for next pandemic preparedness. (Figure Presented).
ABSTRACT
Introduction: Inpatient rehabilitation (IPR) is crucial to recovery after stroke. COVID-19, however, has led to delays in post-stroke admission to IPR due to transmission concerns. Objective: We evaluated the effect of time from stroke onset to IPR admission on post-stroke recovery Design: A retrospective analysis of 680 patients with acute stroke or intracerebral hemorrhage (ICH), admitted to IPR between APR-2017 and AUG-2019. Association between time from stroke onset to IPR and discharge FIM-Motor Total and FIM-Motor Total with transfers scores was studied, after adjusting for sex, age at onset, stroke severity and type. Multiple linear regression models were conducted for outcomes discharge: (FIM-Motor Total) and (FIM-Motor Total with transfers) (Table 1). Square transformations were used to satisfy model assumptions. Ordinal logistic regression models were run for outcomes discharge FIM subset scores categorized as independent (6-7), needs supervision (5), and needs assistance (1-4, reference). The primary variable of interest was days onset to IPR, adjusted for stroke severity (admit FIM subset scores), sex, stroke type and age. (Table 2). The proportional odds assumption was verified using Brant test. Results: An inverse relationship was observed between days from onset to IPR and discharge FIMMotor with and without transfers. Time from stroke onset to IPR admission was associated with decreased discharge FIM-Motor and FIM-Motor with transfers, after adjusting for other covariates. Among FIM subset discharges, an additional day also resulted in a 2-5% decrease in the odds of being more independent. Conclusion: Delays to IPR admission result in decreased motor function gains and lower chance of independence. In addition to current community education practices, acute care hospitals and IPR facilities must review their processes to remove delays. These processes include requirements for COVID disease testing and IPR acceptance policies.