Analyze changes in stroke presentation and in-hospital systems-of-care at a Comprehensive Stroke Center (CSC) during the first year of the SARS-CoV-2 pandemic.

Although studies have shown a decrease in hospital stroke admissions during the pandemic, population-based studies investigating the evolution of stroke metrics throughout the pandemic are lacking.

From March 2018 to May 18, 2021, data from 2400 stroke admissions to our CSC were obtained. The study duration was split into 4 periods according to changes in local case numbers and community restrictions: period 0 (prepandemic), period 1 (first wave), period 2 (lull), and period 3 (second wave). Monthly intravenous thrombolysis (IVT) and endovascular therapy (EVT) rates and workflow times were compared among periods. Analyses were adjusted for age, sex, comorbidities, and need for continuing care.

Stroke monthly admissions decreased in period 1 (β = -6.39, p < 0.001), recovered in period 2 (β = 9.20, p < 0.001), and dropped again in period 3 (β = -3.85, p = 0.04). Although admissions increased in period 2, they did not reach prepandemic levels. Incidence of IVT also significantly dropped on period 1 (β = -0.71, p = 0.04) and then rose in period 3 (β = 1.30, p < 0.001). Compared with the prepandemic period, recipients of acute stroke therapies during period 2 had prolonged door-to-CT times (adjusted difference 25 min, 95%CI 4.69-36.09 min). Moreover, in-hospital door-to-needle and groin-to-reperfusion times were also delayed in periods 2 and 3.

We observed a significant decrease in stroke admissions and IVT treatment during the first COVID-19 wave, reflecting less care-seeking in our community initially. Further, during the lull period and second wave, significant acute stroke in-hospital workflow delays occurred. Going forward, additional measures are needed to reduce barriers to workflow and hospital avoidance for stroke patients during pandemic or other local crisis periods.