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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Delayed presentation of acute ischemic strokes during the COVID-19 crisis
Clemens M Schirmer1,2,3, Andrew J Ringer4, Adam S Arthur5,6
1Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Wilkes-Barre, PA, United States cmschirmer@gmail.com.
Insights
The COVID-19 pandemic caused delays in emergency care, with acute ischemic stroke patients presenting later to stroke centers. This study found a significant increase in the time from last-known-well to presentation during the pandemic.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly altered global healthcare access and patient behavior.
- Public awareness and restrictions impacted the perceived urgency for seeking care for acute conditions.
Purpose of the Study:
- To investigate delays in presentation for acute ischemic stroke patients during the initial phase of the COVID-19 pandemic in the US.
- To compare presentation times and stroke severity before and during the pandemic.
Main Methods:
- Retrospective analysis of 710 acute ischemic stroke patients across 12 US stroke centers.
- Comparison of presentation intervals (last-known-well to presentation) between a baseline period (Feb-Mar 2019) and the early pandemic period (Feb-Mar 2020).
Main Results:
- A decrease in patient volume was observed during the early pandemic months (227 in Feb 2020, 163 in Mar 2020) compared to the baseline (320 total).
- No significant differences in stroke severity or patient age were found between the periods.
- The mean interval from last-known-well to presentation was significantly longer during the COVID-19 period (603 min) versus the baseline (442 min).
Conclusions:
- Findings suggest a link between public awareness of the pandemic, imposed limitations, and delayed presentation of acute ischemic stroke patients.
- The study highlights a critical need to address public perception and access to emergency care during public health crises.
Background:
The COVID-19 pandemic has disrupted established care paths worldwide. Patient awareness of the pandemic and executive limitations imposed on public life have changed the perception of when to seek care for acute conditions in some cases. We sought to study whether there is a delay in presentation for acute ischemic stroke patients in the first month of the pandemic in the US.
Methods:
The interval between last-known-well (LKW) time and presentation of 710 consecutive patients presenting with acute ischemic strokes to 12 stroke centers across the US were extracted from a prospectively maintained quality database. We analyzed the timing and severity of the presentation in the baseline period from February to March 2019 and compared results with the timeframe of February and March 2020.
Results:
There were 320 patients in the 2-month baseline period in 2019, there was a marked decrease in patients from February to March of 2020 (227 patients in February, and 163 patients in March). There was no difference in the severity of the presentation between groups and no difference in age between the baseline and the COVID period. The mean interval from LKW to the presentation was significantly longer in the COVID period (603±1035 min) compared with the baseline period (442±435 min, P<0.02).
Conclusion:
We present data supporting an association between public awareness and limitations imposed on public life during the COVID-19 pandemic in the US and a delay in presentation for acute ischemic stroke patients to a stroke center.
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