Factors Affecting Time-to-Admission in Acute Stroke and Transient Ischemic Attack during the Pandemic Era

ABSTRACT

Background and Aims: The benefits of stroke management is timesensitive. However, healthcare service disruptions and fears related to the COVID-19 pandemic have resulted in reduced stroke admissions. We aim to compare variables associated with early versus late time-toadmissions following acute stroke and transient ischemic attack (TIA) during the pandemic. Method(s) We conducted a prospective cross-sectional study in a 5-month period. Data was collected via questionnaire and guided interview. Descriptive and bivariate chi-square analyses was conducted comparing variables between early and late admission (cut-off 4.5 hours). Result(s) 137 patients were included. Most were male (59.1%) with a mean age of 61.12 (SD +/-13.52). Diagnoses were ischemic stroke (83.2%), hemorrhagic stroke (9.5%), and TIA (7.3%). Median time-to-admission was 7 hours (IQR 2.00-23.00). 60.6% of patients experienced delayed time-to-admission exceeding 4.5 hours. Factors associated with early arrival include a diagnosis of hemorrhagic stroke (p<0.001), symptoms of altered mentation (p<0.001) and visual dysfunction (p=0.001), routine anti-hypertensive usage (p=0.015), higher education level (p=0.004), perceptions of seriousness (p<0.001) and urgency (p<0.001), and recognition of stroke (p<0.001). Being alone during onset of symptoms was significantly associated with delayed arrival (p<0.001). Conclusion(s) A majority of stroke patients were admitted after the golden period, due to failure in recognizing symptoms of stroke and low perceptions of seriousness and urgency. Other factors such as perceived severity of symptoms (i.e., altered mental status, visual dysfunction), a higher education, and routine use of hypertensives, contributes to early arrival. This study can be used to inform future public health intitiatives and campaigns.