The impact of the first wave of COVID-19 on stroke admissions across three tertiary hospitals in Brisbane

Intern Med J. 2022 May 24. doi: 10.1111/imj.15827. Online ahead of print.

Abstract

Background: COVID-19 has caused a global shift in healthcare seeking behaviour, however, presentation rates with serious conditions such as stroke in low COVID-19 prevalence cities has received less attention.

Aims: To determine if there was a significant reduction in stroke admissions, delivery of acute reperfusion therapies, or increased delays to presentation during the first wave of the COVID-19 pandemic.

Methods: A multicentre, retrospective, observational cohort study was performed across three tertiary hospitals in Brisbane, Australia. Cases were identified using ICD-10 codes and then individually reviewed for eligibility using prespecified inclusion and exclusion criteria. All metrics were compared over three months from March 1 to May 31, 2020 with two corresponding 3-month periods in 2018 and 2019.

Results: There was a mean of 2.15 (95% CI 1.87-2.48) stroke admissions per day in the examined pandemic months compared to 2.13 (95% CI 1.85-2.45) and 2.26 (95% CI 1.97-2.59) in March to May 2018 and 2019 respectively, with no significant difference found (p = 0.81). There was also no difference in rates of intravenous thrombolysis (p = 0.82), endovascular thrombectomy (p = 0.93) and time from last known well to presentation (p = 0.54). Conversely, daily emergency department presentations (including non-stroke presentations) significantly reduced (p < 0.0001).

Conclusions: During the early months of the COVID-19 pandemic there was no significant reduction in stroke presentations, use of acute reperfusion therapies or delays to presentation, despite a reduction in ED presentations for any cause. Our results differ from the global experience, with possible explanations including differences in public health messaging and healthcare infrastructure. This article is protected by copyright. All rights reserved.

Keywords: COVID; Covid-19; SARS-CoV-2; coronavirus; pandemic; stroke.