Impact of the COVID-19 pandemic on the clinical practice of strokes in a region of the health system of Spain

Background and Aims: There are concerns that the coronavirus disease 2019 (COVID-19) outbreak negatively afects the quality of care for stroke. We assessed the impact of the COVID-19 outbreak on trends in hospital admissions and workfow parameters of acute stroke care in our region. Methods: The main variables of the study were: stroke admissions, reperfusion therapies, severity of stroke on admission, functional status at discharge, and mortality. Stroke registry data from February through December 2019 and 2020 were collected. For the analysis, all data were grouped by consecutive calendar weeks. We used Poisson regression models, Pearson correlation coefficient and univariate ARIMA time series modeling procedures and the spectral graphs procedure which is used to identify periodic time series. Results: During the COVID-19 period, 319 patients presented with a suspected stroke compared to 407 patients in the 2019 period. Activity in stroke unit decreased compared to 2019. Ischemic stroke decreased by 14%, 289 vs. 248 (p = 0.101);hemorrhagic stroke by 36%, 50 cases vs 32 (p = 0.05) and transient ischemic attacks by 42%, 68 vs 39, (p = 0.012). The proportion of men was higher during the COVID-19 period ( p < 0.01). No differences were observed in the mean scores of NIHSS at admission in the periods. Thrombolytic therapy was reduced by 42% (p = 0.003). However, the mean number of weekly thrombectomies performed remained stable in those periods. Conclusions: We observed a decrease in suspected stroke presentations during the COVID-19 outbreak, with impact in the quality of stroke care, with a reduction in fibrinolytic treatments and care for women.