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Published on: January 15, 2017
Effect of COVID-19 on Emergent Stroke Care: A Regional Experience
Jessica Hsiao1, Emily Sayles1, Eleni Antzoulatos1
1Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH.
Insights
The coronavirus disease 2019 (COVID-19) pandemic mitigation efforts led to a significant decline in stroke consultations and reperfusion treatments. Public education is crucial to prevent patients from avoiding essential emergency care during this health crisis.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Anecdotal evidence suggested COVID-19 mitigation efforts may deter stroke patients from seeking timely treatment.
- This could lead to increased stroke morbidity and mortality.
- Analysis of regional stroke care data during mitigation provides an opportunity to assess this impact.
Purpose of the Study:
- To assess the impact of COVID-19 mitigation measures on acute stroke care.
- To analyze regional Stroke Team activations and reperfusion treatments during the pandemic.
Main Methods:
- Retrospective review of prospectively collected Stroke Team case log data.
- Data from a Stroke Team serving approximately 2 million inhabitants and 30 healthcare facilities.
- Comparison of stroke consultation and reperfusion treatment volumes before and after COVID-19 mitigation announcements, and against the prior calendar year.
Main Results:
- Stroke consultations significantly declined by 39% in the 5 weeks following statewide closure announcements.
- Reperfusion treatments appeared to decline by 31%, with thrombolysis specifically decreasing by 33%.
- Findings were consistent when compared with the prior year and analyzed for time trends.
Conclusions:
- Regional acute stroke consultations decreased significantly following COVID-19 mitigation measures.
- Reperfusion treatment rates, including thrombolysis, also showed a qualitative decline, warranting further investigation.
- Urgent public health education is necessary to address the potential crisis of patients avoiding emergency care due to COVID-19 concerns.
Background And Purpose:
Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities.
Methods:
Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year.
Results:
Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%-46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%-51%), and specifically thrombolysis by 33% (95% CI, 4%-55%), but this finding had less precision.
Conclusions:
Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.
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