Australia sees 37% decline in ‘code stroke’ in COVID-19 pandemic


By Mardi Chapman

3 Sep 2020

Radiologists have reported a significant reduction in stroke imaging and interventions during the early phase of the COVID-19 pandemic and lockdown.

The study, from Monash Health, reinforces concerns that pandemic-related fears have stopped people from presenting to hospital with potentially serious and time-sensitive conditions.

The investigators compared the number of multimodal CTs performed for a ‘code stroke’ workup between March 2019 and May 2020.

The study found the number of patients undergoing multimodal CT per month decreased during the transition month of February 2020 and into the pandemic period, reaching significance in April (p <0.0025).

The total number of ‘code stroke’ activations also declined from the pre-pandemic period through February 2020, and then dropped more significantly in the initial lockdown.

The total number of ED presentations and ED patients who underwent CT also decreased significantly during the pandemic period (p < 0.0025).

“The nadir was in the week of March 27, when the population was placed in lockdown. At this nadir, the number of CTs decreased 68% relative to the weekly average over the pre‐pandemic period,” the study said.

Endovascular clot retrievals (ECRs) also decreased during the pandemic months in the study period compared to the pre-pandemic although the decline was not statistically significant.

“There was a substantial relative year‐on‐year decline across all categories in April, with a 37% decrease in ‘code stroke’ activations, 54% decrease in multimodal CTs and 48% decrease in ECRs performed.”

“In April, the absolute number of patients with LVOs decreased but the percentage was similar to the pre‐pandemic months,” they said.

“Year‐on‐year, there was a mild increase in the number of LVOs in March (+15%), but marked decrease in April (−55%).”

“This suggests, in keeping with our hypothesis, that patients with severe strokes continued to present to hospital during this early pandemic period, while those with mild strokes or stroke mimics may have been deterred from coming into hospital.”

“In April, following the lockdown and peak in new COVID‐19 cases, the number of patients presenting with LVOs decreased in alignment with the decrease in patients undergoing multimodal CT.”

In a “thin silver lining”, the median door‐to‐CT time decreased from 22 minutes during the pre‐pandemic months to just nine minutes during the pandemic months of March and April.

“This was attributed to reduced congestion of our emergency departments, which we speculate may have helped expedite patient transfer to the radiology department for multimodal CT.”

The investigator noted that the prevalence of SARS-CoV-2 infection was low in the first wave of the pandemic, and did not overwhelm emergency medical services.

“We therefore conclude that avoidance of hospitals, driven by fear of contracting COVID‐19 and strict adherence to the lockdown, was the most cause for this dramatic decrease in stroke patients, including those who may have benefitted from treatment.”

“Such indirect effects of the pandemic may have greater impact than the pandemic itself.”

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