A.1 Changes in ischemic stroke presentations and associated workflow during the first wave of the COVID-19 pandemic: A population study. (June 2022)

• Record Type: Journal Article
• Authors: Ganesh, A; Stang, JM; McAlister, FA; Shlakhter, O; Holodinsky, JK; Mann, B; Hill, MD; Smith, EE
• Is Part Of: Canadian journal of neurological sciences. Volume 49(2022)Supplement 1
• Page Start: S3
• Page End: S3
• Publication Date: 2022-06
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Electronic journals; 616.8
• DOI: 10.1017/cjn.2022.91
• Languages: English
• ISSNs: 0317-1671

Abstract

Abstract : Background: Pandemics may promote hospital avoidance among patients with emergencies, and added precautions may exacerbate treatment delays. Methods: We used linked administrative data and data from the Quality Improvement and Clinical Research Alberta Stroke Program – a registry capturing stroke-related data on the entire Albertan population (4.3 million) – to identify all patients hospitalized with stroke in the pre-pandemic (01/01/2016-27/02/2020) and COVID-19 pandemic (28/02/2020-30/08/2020) periods. We examined changes in stroke presentation rates and use of thrombolysis and endovascular therapy (EVT), adjusted for age, sex, comorbidities, and pre-admission care needs; and in workflow, stroke severity (National Institutes of Health Stroke Scale/NIHSS), and in-hospital outcomes. Results: We analyzed 19, 531 patients with ischemic stroke pre-pandemic versus 2, 255 during the pandemic. Hospitalizations/presentations dropped (weekly adjusted-incidence-rate-ratio[aIRR]:0.48, 95%CI:0.46-0.50), as did population-level incidence of thrombolysis (aIRR:0.49, 0.44-0.56) or EVT (aIRR:0.59, 0.49-0.69). However, proportions of presenting patients receiving thrombolysis/EVT did not decline (thrombolysis:11.7% pre-pandemic vs 13.1% during-pandemic, aOR:1.02, 0.75-1.38). For out-of-hospital strokes, onset-to-door times were prolonged(adjusted-coefficient:37.0-minutes, 95%CI:16.5-57.5), and EVT recipients experienced greater door-to-reperfusion delays (adjusted-coefficient:18.7-minutes, 1.45-36.0). NIHSS scores and in-hospital mortality did not differ. Conclusions: The first COVID-19 wave was associated with a halving of presentations and acute therapy utilization for ischemic stroke at a population level, and greater pre-/in-hospital treatment delays. Our data can inform public health messaging and stroke care in future pandemic waves.