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Published on: January 15, 2017
Changes in Prehospital Stroke Care and Stroke Mimic Patterns during the COVID-19 Lockdown
Kazimieras Melaika1, Lukas Sveikata2,3, Adam Wiśniewski4
1Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania.
Insights
COVID-19 lockdowns negatively impacted prehospital stroke care, reducing stroke alerts and triage quality. Delays increased, and stroke mimics like seizures and tumors became more common, highlighting the need for better public health emergency strategies.
Area of Science:
- Neurology
- Public Health
- Emergency Medicine
Background:
- The COVID-19 pandemic and associated lockdowns have raised concerns about their impact on emergency medical services.
- Prehospital stroke care is time-sensitive, and disruptions could lead to poorer patient outcomes.
Purpose of the Study:
- To compare stroke care patterns before and during a state-wide COVID-19 lockdown in Lithuania.
- To assess changes in stroke alert volume, triage quality, and patient arrival times.
Main Methods:
- Prospective analysis of stroke alerts referred to a stroke center.
- Comparison of data from 15 weeks pre-lockdown and 13 weeks during lockdown (March-June 2020).
- Evaluation of stroke alert rates, admission rates, triage accuracy, and onset-to-door times.
Main Results:
- A significant decrease in stroke alerts (RR 0.61) and admissions (RR 0.63) during lockdown.
- Reduced prehospital stroke triage quality (PPV 72.1% vs. 79.9%, p=0.042).
- Increased onset-to-door time (153.0 vs. 120.5 min, p=0.049) and a higher proportion of stroke mimics (seizures, intracranial tumors).
Conclusions:
- The COVID-19 lockdown led to a decline in prehospital stroke care quality and increased delays, despite low COVID-19 incidence.
- Stroke mimics were more frequent during the lockdown period.
- Enhanced strategies are necessary to ensure optimal neurological care during public health emergencies.
Abstract:
The impact of COVID-19 lockdown on prehospital stroke care is largely unknown. We aimed to compare stroke care patterns before and during a state-wide lockdown. Thus, we analysed prospective data of stroke alerts referred to our stroke centre between 1 December 2019 and 16 June 2020, and compared them between two periods-15 weeks before and 13 weeks during the state-wide lockdown declared in Lithuania on 16 March 2020. Among 719 referrals for suspected stroke, there was a decrease in stroke alerts (rate ratio 0.61, 95% CI (0.52-0.71)), stroke admissions (0.63, 95% CI (0.52-0.76)), and decrease in prehospital stroke triage quality (positive predictive value 72.1% vs. 79.9%, p = 0.042) during the lockdown. The onset-to-door time was longer (153.0 vs. 120.5 min, p = 0.049) and seizures and intracranial tumours were more common among stroke mimics (16.9% vs. 6.7%, p = 0.012 and 9.6% vs. 3.0%, p = 0.037, respectively). We conclude that there was a decline in prehospital stroke triage quality during the lockdown despite low COVID-19 incidence in the country. Moreover, we observed an increase in hospital arrival delays and severe conditions presenting as stroke mimics. Our findings suggest that improved strategies are required to maintain optimal neurological care during public health emergencies.
