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Stroke patterns and outcomes during the second wave of COVID-19 pandemic: a cross-sectional study
Bikram P Gajurel1, Subarna Giri2, Parishma Tamrakar3
1Department of Neurology, Tribhuvan University Teaching Hospital.
Insights
The COVID-19 pandemic caused delays in stroke treatment, with arranging vehicles being a common prehospital delay. Hospital stay duration and NIHSS score predict stroke outcomes.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted stroke care, affecting patient admissions, treatment timeliness, and quality metrics.
- Understanding these impacts is crucial for optimizing stroke management strategies during health crises.
Purpose of the Study:
- To investigate stroke types, treatment delays, and outcome predictors during the second wave of the COVID-19 pandemic.
- To analyze prehospital delays and their impact on patient outcomes.
Main Methods:
- A single-centered prospective cross-sectional study conducted from May to November 2021.
- Inclusion of 64 patients with stroke, collecting data on demographics, stroke types, outcomes, and prehospital delays.
- Binary logistic regression used to identify predictors of 3-month outcomes.
Main Results:
- Ischemic stroke was more prevalent than hemorrhagic stroke.
- The median emergency room arrival time was 24 hours, with vehicle arrangement delays being the most common prehospital delay.
- Median hospital stay duration and baseline National Institute of Health Stroke Scale (NIHSS) score were significant predictors of good 3-month outcomes.
Conclusions:
- Addressing factors contributing to delayed hospital transfer and treatment initiation is essential.
- Patient prognosis counseling can be enhanced by considering NIHSS scores and hospital stay duration.
- Developing mechanisms to reduce prehospital delays at both ground and policy levels is recommended.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic has affected the number of stroke activations, admission of patients with various types of strokes, the rate and timely administration of reperfusion therapy, and all types of time-based stroke-related quality assessment metrics. In this study, we describe the different types of strokes, different delays in seeking and completing treatment occurring during the second wave of the COVID-19 pandemic, and predictors of outcome at 3 months follow-up.
Materials And Methods:
This is a single-centered prospective cross-sectional study carried out from May 2021 to November 2021, enrolling patients with stroke. Data collected were demographic characteristics, stroke types and their outcomes, and different types of prehospital delays.
Results:
A total of 64 participants were included in the study with a mean age of 60.25±15.31 years. Ischemic stroke was more common than hemorrhagic stroke. The median time of arrival to the emergency room of our center was 24 h. The most common cause of prehospital delay was found to be delays in arranging vehicles. The median duration of hospital stays [odds ratio (OR)=0.72, P<0.05] and baseline NIHSS (National Institute of Health Stroke Scale) score (OR=0.72, P<0.05) were found to be a predictor of good outcomes at 3 months follow-up on binary logistic regression.
Conclusion:
The factors that cause the delayed transfer to the hospital and onset of treatment should be addressed. Patient counseling about the likely prognosis can be done after evaluating the probable outcome based on the NIHSS score and median duration of hospital stay. Nevertheless, mechanisms should be developed to reduce the prehospital delay at the ground level as well as at the policy level.
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