Acute telestroke evaluations during the COVID-19 pandemic

Area of Science:

• Neurology
• Public Health
• Telemedicine

Background:

• The COVID-19 pandemic significantly impacted healthcare delivery globally.
• Telestroke services are crucial for managing acute ischemic stroke (AIS) in remote areas.
• Understanding the pandemic's effect on stroke care access and patient characteristics is vital.

Purpose of the Study:

• To analyze the impact of COVID-19 on telestroke request volumes.
• To characterize patients evaluated for AIS via telestroke during the pandemic.
• To compare patient demographics and stroke severity during the pandemic versus a pre-pandemic period.

Main Methods:

• Retrospective database review of telestroke requests at an academic center network (USA).
• Data collected from March 15 to April 30, 2020, compared with the same period in 2019.
• Analysis included patient age, National Institutes of Health Stroke Scale (NIHSS), diagnosis (AIS/TIA), and treatments (IV-rtPA, ET).

Main Results:

• A 53% decrease in telestroke evaluations occurred in 2020 compared to 2019 (p < 0.00001).
• Mean NIHSS was higher in 2020 (9.1) vs. 2019 (7.2), though not statistically significant (p=0.122).
• Patients with suspected AIS/TIA were younger in 2020 (mean age 60.5) vs. 2019 (mean age 67.0) (p=0.038).

Conclusions:

• The pandemic led to a significant reduction in telestroke utilization.
• Higher stroke severity (NIHSS) and younger patient age in AIS/TIA cases suggest potential COVID-19 related thrombotic complications in atypical populations.
• These findings highlight the need to maintain stroke care access during public health crises and investigate novel stroke etiologies.