The Impact of COVID-19 Pandemic on Acute Stroke Presentation, Timing, and Outcomes: A Retrospective Observational Cohort Study of Consecutive Patient Regional Registry (Preprint)
Authors: Gealogo Brown Gretchel , Foroughi Razieh , Bandela Sujani , Cardentey Agnelio , Clark Kal L. , Dula Adrienne N. 
Published: April 2022

BACKGROUND

As the pandemic has evolved, there has been a growing concern on the probable adverse effect of isolation and social distancing on different aspects of stroke. There is, however, limited data on the possible effects of the pandemic on maintaining stroke quality time metrics.

OBJECTIVE

The purpose of this study was to identify the impact of COVID-19-related “shelter in place” restrictions on critical time metrics for treatment and outcomes of stroke patients in two metropolitan Texas cities with known historical differences in stroke risk, incidence, and prevalence: Austin and San Antonio.

METHODS

Patient data from stroke program accreditation registries in Austin and San Antonio were compared between two treatment periods: (1) during the state’s COVID-19 “shelter in place” restriction period, and (2) the corresponding period during the previous year. Timing metrics were time last known well (TLKW) to arrival ≤ 3 hours, arrival to imaging initiation ≤ 25 minutes, and arrival to administration of thrombolytic ≤ 60 minutes. Primary outcomes included dichotomized process measures: TLKW to arrival, arrival to brain imaging initiation, and arrival to administration of thrombolytic therapy. Secondary outcomes were clinical endpoints: independent ambulation at discharge, discharge to home, in-hospital mortality.

RESULTS

Presentation and process measure trends for Austin patients during pre- and COVID-19 restriction periods were comparable other than TLKW to arrival, which increased during COVID-19. For San Antonio patients during COVID-19, there was increased TLKW to hospital arrival and increased time between hospital arrival to imaging initiation, even though the number of hospital arrivals < 4.5 hours from symptom onset decreased. Differences in pre- and during-COVID periods were found primarily in outcome measures for both Austin and San Antonio patients. Compared to the pre-COVID period, Austin patients had decreased length of stay (LOS), a decrease in number of discharges to hospice, and increase in patients with no symptoms on final assessment. On the other hand, more post-COVID-19 San Antonio patients than pre-COVID-19 had independent ambulation at discharge and were discharged to home, with a larger proportion of patients ranging from moderate disability/able to walk unassisted to no symptoms.

CONCLUSIONS

Austin and San Antonio patients did not hesitate to seek treatment for stroke symptoms during the COVID-19 restriction period, and longer times between TLKW and hospital arrival did not impact arrival-to-imaging and arrival-to-treatment times nor patient outcomes, even in patients at higher risk for stroke. Future studies should continue to assess the impact of COVID-19 on stroke care and outcomes pre- and post-introduction of the COVID-19 vaccine, and as infectivity rates spike or recede.

CLINICALTRIAL

Not applicable