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Regional Changes in Patterns of Stroke Presentation During the COVID-19 Pandemic
- Source :
- Stroke, Vol. 52, No 4 (2021) pp. 1398-1406, Stroke
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Background and Purpose: Patient care-seeking has likely changed during the coronavirus disease 2019 (COVID-19) pandemic. In stroke, delayed or avoided care may translate to substantial morbidity. We sought to determine the effect of the pandemic on patterns of stroke patient presentation and quality of care. Methods: We analyzed data from 25 New England hospitals: one urban, academic comprehensive stroke center and telestroke hub, and 24 spoke hospitals in the telestroke network. We included all telestroke consultations from the 24 spokes, and all stroke admissions to the comprehensive stroke center hub from November 1, 2019 through April 30, 2020. We compared rates of presentation, timeliness presentation, and quality of care pre- versus post-March 1, 2020. We examined trends in patient demographics, stroke severity, timeliness, diagnoses including large vessel occlusion, alteplase use, and endovascular thrombectomy among eligible subjects. We compared proportions and bivariate comparisons to examine for changes pre- versus post-March 1, 2020 and used linear regression to examine trends over time. Results: Among 1248 patient presentations (844 telestroke consultations, 404 comprehensive stroke center admissions), telestroke consultations and ischemic stroke patient admissions decreased among the spokes and hub. Age and stroke severity were unchanged over the study period. We found no change in alteplase administration at telestroke spoke hospitals but did note a decrease in both alteplase use and thrombectomy at our comprehensive stroke center. Time metrics for patient presentation and care delivery were unchanged; however, rates of adherence for the quality measures dysphagia screening, early antithrombotic initiation, and early venous thromboembolism prophylaxis were reduced during the pandemic. Conclusions: In this regional analysis, we found decreasing telestroke consultations and ischemic stroke admissions, and reduced performance on stroke quality of care measures during the COVID-19 pandemic. Contrary to prior reports, we did not find an increase in thrombectomy nor decrease in clinical severity that might be expected if patients with milder symptoms avoided hospitalization.
- Subjects :
- Male
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
Stroke severity
Article
New England
Epidemiology
Pandemic
medicine
Humans
In patient
Pandemics
Stroke
Aged
Retrospective Studies
Demography
Thrombectomy
Aged, 80 and over
Advanced and Specialized Nursing
Delivery of Health Care, Integrated
business.industry
COVID-19
Retrospective cohort study
Middle Aged
medicine.disease
Telemedicine
Hospitals
Emergency medicine
Female
Neurology (clinical)
Morbidity
Presentation (obstetrics)
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15244628 and 00392499
- Volume :
- 52
- Database :
- OpenAIRE
- Journal :
- Stroke
- Accession number :
- edsair.doi.dedup.....1015dced6f11fe6ddb3d6e35e62996ca