Acute Stroke Care during the COVID-19 Pandemic: Reduction in the Number of Admissions of Elderly Patients and Increase in Prehospital Delays

Abstract

<b><i>Introduction:</i></b> We analyzed whether the coronavirus disease 2019 (COVID-19) crisis affected acute stroke care in our center during the first 2 months of lockdown in Spain. <b><i>Methods:</i></b> This is a single-center, retrospective study. We collected demographic, clinical, and radiological data; time course; and treatment of patients meeting the stroke unit admission criteria from March 14 to May 14, 2020 (COVID-19 period group). Data were compared with the same period in 2019 (pre-COVID-19 period group). <b><i>Results:</i></b> 195 patients were analyzed; 83 in the COVID-19 period group, resulting in a 26% decline of acute strokes and transient ischemic attacks (TIAs) admitted to our center compared with the previous year (<i>p</i> = 0.038). Ten patients (12%) tested positive for PCR SARS-CoV-2. The proportion of patients aged 65 years and over was lower in the COVID-19 period group (53 vs. 68.8%, <i>p</i> = 0.025). During the pandemic period, analyzed patients were more frequently smokers (27.7 vs. 10.7%, <i>p</i> = 0.002) and had less frequently history of prior stroke (13.3 vs. 25%, <i>p</i> = 0.043) or atrial fibrillation (9.6 vs. 25%, <i>p</i> = 0.006). ASPECTS score was lower (9 [7–10] vs. 10 [8–10], <i>p</i> = 0.032), NIHSS score was slightly higher (5 [2–14] vs. 4 [2–8], <i>p</i> = 0.122), onset-to-door time was higher (304 [93–760] vs. 197 [91.25–645] min, <i>p</i> = 0.104), and a lower proportion arrived within 4.5 h from onset of symptoms (43.4 vs. 58%, <i>p</i> = 0.043) during the CO­VID-19 period. There were no differences between proportion of patients receiving recanalization treatment (intravenous thrombolysis and/or mechanical thrombectomy) and in-hospital delays. <b><i>Conclusion:</i></b> We observed a reduction in the number of acute strokes and TIAs admitted during the COVID-19 period. This drop affected especially elderly patients, and despite a delay in their arrival to the emergency department, the proportion of patients treated with recanalization therapies was preserved.