Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom
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ORIGINAL ARTICLE
Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom Nishita Padmanabhan 1,2
&
Indira Natarajan 1 & Rachel Gunston 1 & Marko Raseta 3 & Christine Roffe 1,2
Received: 19 August 2020 / Accepted: 25 September 2020 # The Author(s) 2020
Abstract Introduction The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. Methods This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stokeon-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). Results There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. Conclusions During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality. Keywords Stroke . COVID-19 . Thrombolysis . Thrombectomy . Infarct . Mortality
Introduction * Nishita Padmanabhan [email protected] Indira Natarajan [email protected] Rachel Gunston [email protected] Marko Raseta [email protected] Christine Roffe [email protected] 1
Neurosciences, Royal Stoke University Hospital, Stoke-on-Trent, UK
2
Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
3
Statistics and Mathematical Modelling, Department of Molecular Genetics, Erasmus MC, Rotterdam, Netherlands
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. As of September 21st, 2020, there are 30,675,675 confirmed COVID-19 cases and 954,417 confirmed deaths in over 216 countries/territories worldwide [1]. The United Kingdom (UK), with 390,362 confirmed cases and 41,759 confirmed deaths, continues to have community transmission at present [1]. COVID-19 is associated with a hypercoagulable state that may lead to an increase
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