Worse discharge outcomes of stroke patients during the COVID-19 pandemic: A dual-network experience

ABSTRACT

Background and Purpose: The novel coronavirus of 2019 (COVID-19) has been associated with worse outcomes for hospitalized patients across the US and worldwide. Our study investigates the effect of the pandemic on functional outcomes for patients presenting with stroke-like symptoms in two high-volume Tele-Stroke networks. Methods: We performed retrospective chart review of 7689 consecutive patients seen through two Tele-Stroke networks (Medical University of South Carolina and Augusta University) from July 2019 through May 2020. Discharge outcomes were assessed using modified Rankin scale (mRS). We dichotomized patients to preCOVID-19 pandemic (July 2019 to February 2020) and during COVID- 19 pandemic (March to May 2020). Results: During COVID, a higher percentage of patients received intravenous tissue plasminogen activator (tPA) (14.2% vs 11.3% before, p=0.001), despite a similar baseline NIHSS. Also, patients during the pandemic had a shorter symptom-onset to hospital door time (288 vs 353, P=0.012). Demographics were similar between groups, other than older age in patients presenting during COVID (66.02 vs 65.15 before, p=0.04) (table 1). During the pandemic, a higher percentage of patients had a poor functional outcome, as defined by mRS 3-6 (35.7% vs 30% before, p=0.012), and a higher percentage died or were discharged to hospice (7.0% vs 5.1%, p=0.000). Conclusions: Despite earlier ED presentation and increased tPA administration, our results demonstrate worse discharge outcomes during the pandemic in two large telestroke networks. Changes in workflow and resulting delays during COVID-19 may explain these findings.