Haitham Hussein1, David Schneck2, Nitin Ramanujam Chakravarthula3, Annette Xenopoulos-Oddsson2, Mark Fiecas4
1Neurology, University of Minnesota Medical School, 2Masonic Institute for the Developing Brain, 3Neurology, 4Division of Biostatistics, University of Minnesota
Objective:
To determine the impact of COVID-19 pandemic on stroke presentations in a statewide database.
Background:
The COVID-19 pandemic has had a profound impact on healthcare worldwide, with numerous stroke patients avoiding medical care during this time, resulting in adverse outcomes.
Design/Methods:
We conducted a retrospective analysis of the Minnesota Hospital Association database which contains individual-level data. Using ICD-10 codes, adult patients admitted in 2019 (pre-pandemic group) and 2020 (pandemic group) with any stroke diagnosis were identified. Monthly volume trends were analyzed across the two. The two groups were compared in terms of demographics, geography, stroke types, therapies, and outcomes. The Standardized Mean Difference (SMD) is reported for each variable as a method to compare the two groups with values ≥0.1 indicating a noteworthy imbalance between groups.
Results:
Total stroke volume dropped from 17,249 in 2019 to 16,236 in 2020 (𝜒2=45.1, p<0.001). Non-Hispanic White patients experienced the most pronounced drop (SMD 0.125). A larger proportion of stroke cases were in urban compared to rural regions in 2020 (73.9%) compared to 2019 (68.7%). There was a sharp decline in volume in March-April 2020, aligning with stay-at-home orders, with subsequent increase in stroke volume despite the rise in COVID volume. Fewer ischemic stroke patients received reperfusion therapies, however, the utilization rates of IV thrombolysis (SMD 0.021) and mechanical thrombectomy (0.036) were similar. Length of stay and total charges were higher in 2020 especially for ischemic stroke patients who received reperfusion therapies. Mortality and non-home discharge rates were similar.
Conclusions:
The decline in stroke cases was primarily associated with the stay-at-home orders rather than the actual COVID case volume. It is important to message the public in a manner that does not deter from seeking immediate care for non-COVID medical emergencies.