Regional changes in patterns of stroke presentation during the COVID-19 pandemic

ABSTRACT

Introduction: Patterns of hospital presentation have changed during the COVID-19 pandemic. In stroke, delayed or avoided care may translate to substantial morbidity. We sought to determine the effect of the pandemic on patterns of stroke patient presentation and quality of care. Methods: We analyzed data from 25 New England hospitals one urban, academic comprehensive stroke center (CSC) and telestroke hub, and 24 spoke hospitals in the telestroke network. We included all telestroke consultations from the 24 spokes and stroke admissions to the CSC from 11/1/2019 through 4/30/2020. We examined trends in stroke presentation including large vessel occlusion (LVO), alteplase use, and endovascular thrombectomy among eligible subjects. We compared proportions and bivariate comparisons to examine for changes pre- vs. post-3/1/2020, and used linear regression to examine trends over time. Results: Among 1248 patient presentations, telestroke consultations (0.4 fewer consults per week, p=0.005) and ischemic stroke patient admissions (decrease of 0.2 patients per week, p=0.04) decreased among the spokes and hub. Age and stroke severity were unchanged over the study period. We found no change in alteplase administration at telestroke spoke hospitals, but did note a decrease in both alteplase use (1.5 per week prior to March 1 and 1 per week after, p=0.05) and thrombectomy at our CSC (0.1 fewer cases per week, p=0.02). Time metrics for patient presentation and care delivery were unchanged, however, rates of adherence for several quality measures were reduced during the pandemic (Table 1). Conclusions: In this regional analysis, we found decreasing telestroke consultations and ischemic stroke admissions, and reduced performance on stroke quality of care measures during the COVID 19 pandemic. Contrary to prior reports, we did not find an increase in thrombectomy nor decrease in clinical severity that might be expected if patients with milder symptoms avoided hospitalization.(Figure Presented).