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STROKE SERVICE ACTIVITY AND REPERFUSION TRENDS BEFORE AND DURING THE SARS-COV-2 PANDEMIC – A MULTICENTRE TIME SERIES ANALYSIS
Abstract
Background and Aims
This study aims to measure the changes in volume of ischaemic stroke and TIA presentations across various hospitals internationally and whether the pandemic has reduced the number and proportion of patients receiving reperfusion therapies.
Methods
Three centres from Australia, and one centre each from England, Canada, USA, and Italy described presentation numbers for ischaemic stroke, TIA, intravenous thrombolysis (IVT) , and endovascular thrombectomy (EVT) over a baseline pre-COVID period (April 2018 to March 2020), and an intra-COVID period (March 2020 to March 2021). Interrupted time series analysis using autoregressive integrated moving average techniques was used to measure the impact of the pandemic.
Results
A total of 14,607 ischaemic stroke and 6,424 TIA presentations were included. Of the ischaemic strokes, there were 1,856 (12.7%) instances of intravenous thrombolysis and 2,298 (15.7%) instances of EVT. There was a 5.6% decline in ischaemic stroke presentations (estimate: -23, SE=11, p<0.05) and 16.4% decline in instances of IVT (estimate: -9, SE=2, p<0.001). Neither presentations to TIA clinic (estimate: 6, SE=4, p=0.16) nor EVT counts (estimate: 1, SE=4.80, p=0.91) changed significantly. The percentage of ischaemic strokes receiving IVT decreased from 13.2% to 11.6% (p<0.05), while those requiring EVT did not change (15.4 to 16.5%, p=0.09).
Conclusions
There was a significant reduction in monthly ischaemic stroke counts, thrombolysis counts, and proportion receiving thrombolysis during the pandemic. The disproportionate decrease in IVT during this period suggests that patients may be presenting outside the IVT window during the pandemic.