see below

Reports suggest that acute stroke triage and treatment may have been delayed during the beginning of COVID due to patient reluctance for hospital presentation.Furthermore,we hypothesize that stroke patients with mild symptoms NIHSS<=5,rather than disabling NIHSS>5,are more likely to present in a delayed fashion during the pandemic,compared to before.

We used Get with The Guidelines Stroke registry to identify stroke patients that presented between Jan1 and Aug31,2020 to the University Hospital in San Antonio,Texas.The cohort was stratified by date of presentation(before COVID:Jan 1–Mar15 and during COVID: Mar16–Aug31)and presenting NIHSS(<=5vs>5). We then analyzed by the thrombolytic exclusion criteria “delay to arrival” and time interval of stroke symptoms discovery to hospital presentation.These outcomes were further stratified by age,sex,and ethnicity;race was excluded due to 90%Caucasian cohort.

A total of 294 subjects were included of which 115 were before and 179 were during COVID.There were no significant differences in the demographics for before and during,although a trend for greater male presentation was seen during COVID (Table1)When comparing before and during COVID, the time interval of stroke symptoms discovery to hospital arrival(Table2)and thrombolytic exclusion criteria “delay to arrival”(Table3)were not significantly different across all subgroups dichotomized by NIHSS<=5

Despite dichotomizing our cohort by low NIHSS, we did not demonstrate a significant time delay in acute stroke presentation to our hospital when comparing before and during COVID. Although our study included a large Hispanic population, the cohort was primarily Caucasian; and therefore, the results have limited application to other races. Whether men were more likely than women to present with stroke during COVID is unclear but warrants further study with a larger sample size.Table1:Demographic comparisons for before COVID (Jan1–Mar15) and during COVID (Mar16–Aug31).

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