Quantifying Changes in Acute Stroke Presentations and Associated Workflow During the COVID-19 Pandemic: A Population-based Study (4673)

• DOI: 10.1212/wnl.96.15_supplement.4673
• Publication Date: 2023-12-07T05:55:31Z
• Authors: Aravind Ganesh; Jillian M. Stang; Finlay A. McAlister; Michael D. Hill; Eric E. Smith
• Keywords: Pandemic; 2019-20 coronavirus outbreak; Stroke; Acute stroke

Objective: To understand the effect of COVID-19 pandemic on presentation and treatment acute ischemic stroke. Background: Pandemics may result in hospital avoidance among patients with emergencies, added demands precautions during stroke codes exacerbate delays. There is a paucity population-based data these phenomena. Design/Methods: We extracted from Quality Improvement Clinical Research(QuICR) Alberta Stroke Program, Canadian registry capturing stroke-related entire population Alberta, Canada. used linked administrative to identify all hospitalized pre-COVID-19(1-January- 2016 27-February-2020) post-COVID-19 (28-February-2020 30-June-2020). Poisson regressions evaluate changes hospitalizations use thrombolysis endovascular therapy(EVT), adjusted for age, sex, comorbidities, continuing care needs. compared proportions receiving using logistic regressions, workflow metrics severity (National Institutes Health Scale, NIHSS) generalized linear models. Results: analyzed 19,531 pre-COVID-19 versus 1,400 postCOVID-19. Hospitalizations dropped (weekly aIRR:0.49,95%CI 0.46-0.52), as did incidence (aIRR:0.50,0.42-0.59) EVT (aIRR:0.56,0.44-0.72). However, presenting were unchanged (thrombolysis 12.9% pre- post-COVID, aOR:0.86,0.58-1.29;EVT 6.2% vs 6.8% aOR:1.30, 0.91-1.84). Call-to-ambulance-dispatch call-toparamedics-on-scene times prolonged (adjusted-coefficient call-toparamedics-on-scene:9.05min, 5.41-12.7), recipients experienced greater delay CT-to-groin-puncture door-to-groin-puncture (e.g. median 53min, IQR 35-79 73min, 44-108 post-COVID;adjusted-coefficient: 15.33min, 95%CI 2.09-28.6). Among treated patients, there no relevant differences NIHSS, onset-to-call, door-to-CT, or door-to-needle times. Conclusions: The was associated halving presentations therapies at level, pre-hospital in-hospital Our results help inform public health messaging optimize workflow.