Impact of Covid-19 on Stroke Code Activations, Process Metrics, and Diagnostic Error

Area of Science:

• Neurology
• Public Health
• Emergency Medicine

Background:

• The COVID-19 pandemic prompted significant public health measures impacting healthcare delivery.
• Stroke code activations (SCA) are critical for timely stroke diagnosis and treatment.

Purpose of the Study:

• To analyze stroke code activations during the COVID-19 pandemic.
• To assess the pandemic's impact on stroke diagnosis and care processes.

Main Methods:

• Retrospective review of stroke code activations (SCA) in a comprehensive stroke center.
• Classification of SCA into pre-pandemic and COVID-19 pandemic periods.
• Comparison of true positive stroke diagnoses, door-to-CT times, and diagnostic errors between periods.

Main Results:

• Emergency Department (ED) SCA initially decreased then recovered, with a significant increase in true positive stroke diagnoses (44.2% vs 61.1%).
• Door-to-CT time increased (p = 0.001), and diagnostic errors rose in the ED cohort (p = 0.016).
• In-hospital SCA showed a sustained decrease with no change in true positive stroke rates.

Conclusions:

• The COVID-19 pandemic led to a dynamic shift in ED SCA, characterized by initial decline, gradual recovery, and a higher proportion of confirmed strokes.
• Despite increased diagnostic delays and errors, early clinical outcomes were not significantly different.
• Findings highlight the need for adaptive stroke care protocols during public health crises.