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Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic
Adam S Jasne1, Pola Chojecka1, Ilavarasy Maran1
1Department of Neurology (A.S.J., P.C., I.M., R.M., M.E., Q.Z., K.N., K.V., M.A., N.P., G.J.F., P.L., N.Z., R.N., H.A., D.N., C.L., D.Y.H., J.S., S.S., K.N.S., L.H.S., R.S.), Yale University School of Medicine, New Haven, CT.
Insights
During the COVID-19 pandemic, fewer stroke patients presented to hospitals, with a 30% decrease in stroke codes. Patient demographics shifted, but stroke severity and outcomes remained similar, highlighting the need for public health awareness campaigns.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Anecdotal evidence suggested a decline in hospital visits for stroke symptoms during the COVID-19 pandemic.
- This study aimed to quantify stroke code trends and patient characteristics during the pandemic's emergence.
Purpose of the Study:
- To analyze stroke code activity and patient data at three Connecticut hospitals during the COVID-19 pandemic.
- To compare stroke patient characteristics and process measures before and during the pandemic at a Comprehensive Stroke Center (CSC).
Main Methods:
- Stroke code data from January 1 to April 28, 2020, were compared with the same period in 2019.
- Statistical models were used to identify declines in stroke code frequency.
- Patient-level data from before and during the pandemic at a CSC were analyzed for demographic and clinical differences.
Main Results:
- A 30% decrease in total stroke codes was observed during the pandemic weeks in 2020 compared to 2019.
- Stroke code activity declined significantly starting in mid-February 2020.
- Pandemic-era stroke patients at the CSC were more likely to have specific comorbidities, public insurance, and live within the CSC city, but stroke severity and early outcomes did not differ.
Conclusions:
- Hospital presentations for stroke symptoms decreased during the COVID-19 pandemic.
- Despite decreased presentation, stroke severity and early outcomes remained consistent.
- Public health initiatives are crucial to encourage patients to seek care for non-COVID-19 emergencies like stroke during the pandemic.
Background:
Anecdotal reports suggest fewer patients with stroke symptoms are presenting to hospitals during the coronavirus disease 2019 (COVID-19) pandemic. We quantify trends in stroke code calls and treatments at 3 Connecticut hospitals during the local emergence of COVID-19 and examine patient characteristics and stroke process measures at a Comprehensive Stroke Center (CSC) before and during the pandemic.
Methods:
Stroke code activity was analyzed from January 1 to April 28, 2020, and corresponding dates in 2019. Piecewise linear regression and spline models identified when stroke codes in 2020 began to decline and when they fell below 2019 levels. Patient-level data were analyzed in February versus March and April 2020 at the CSC to identify differences in patient characteristics during the pandemic.
Results:
A total of 822 stroke codes were activated at 3 hospitals from January 1 to April 28, 2020. The number of stroke codes/wk decreased by 12.8/wk from February 18 to March 16 (P=0.0360) with nadir of 39.6% of expected stroke codes called from March 10 to 16 (30% decrease in total stroke codes during the pandemic weeks in 2020 versus 2019). There was no commensurate increase in within-network telestroke utilization. Compared with before the pandemic (n=167), pandemic-epoch stroke code patients at the CSC (n=211) were more likely to have histories of hypertension, dyslipidemia, coronary artery disease, and substance abuse; no or public health insurance; lower median household income; and to live in the CSC city (P<0.05). There was no difference in age, sex, race/ethnicity, stroke severity, time to presentation, door-to-needle/door-to-reperfusion times, or discharge modified Rankin Scale.
Conclusions:
Hospital presentation for stroke-like symptoms decreased during the COVID-19 pandemic, without differences in stroke severity or early outcomes. Individuals living outside of the CSC city were less likely to present for stroke codes at the CSC during the pandemic. Public health initiatives to increase awareness of presenting for non-COVID-19 medical emergencies such as stroke during the pandemic are critical.
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