Patterns of Seeking Emergent Stroke Care During the COVID-19 Pandemic: A Nebraska Stroke Center Perspective

ABSTRACT

Objective: To determine the influence of the COVID-19 pandemic on seeking timely stroke care in Nebraska. Background: Stroke is the 5th leading cause of mortality in the United States and a major contributor to disability. Timely stroke management has made a significant impact in reducing morbidity and mortality. Reduction in hospital visits for myocardial infarctions and strokes have been reported during current and prior pandemics. Studying changing patterns of seeking stroke care can identify vulnerable populations, increase awareness and improve systems to ensure timely hospital access during the pandemic. Design/Methods: This is a retrospective chart review of patients aged 19-89 years who presented within the acute stroke (24 hour) window at our institution's emergency departments (ED) from 1/1/2020 to 4/30/2020 and 1/1/2019 to 4/30/2019. Interrupted time-series design was used to identify differences between the two time periods in terms of ED acute stroke presentation, presentation within IV thrombolysis and mechanical thrombectomy time windows, stroke admissions, types of stroke, stroke severity, demographics, stroke risk factors and baseline disability. Statistical significance was defined as P-value of ≤ 0.05. Results: 608 eligible patients were identified (mean age 64.1±14.8 years;52% were females);out of which 330 (54%) presented within the stated 2020 time period. Time from last known well (LKW) to presentation was increased during the stated pandemic period (median 8.5 [2-24] hours vs. 6 [2-16] hours;p=0.010). Stroke admissions were higher (82.1 % vs. 70.5 %;p=<0.001). Large vessel occlusion was more common in ischemic stroke patients during the pandemic (10.6% vs 4.1%;p= 0.03). Presentation within the acute stroke window decreased significantly in April 2020 compared to April 2019 (17.9% vs 21.9%;p=0.05). Conclusions: Time from last LKW to ED presentation increased and presentation within the acute stroke window eventually decreased during the pandemic, especially as the pandemic spread within Nebraska.