Admissions for Stroke and Strategies to Optimize Healthcare Delivery During the COVID-19 Pandemic - Experience from a Tertiary Care Hospital in South India

BACKGROUND COVID-19 is associated with a hypercoagulable state and stroke is one of its most common neurological complications. The current study is aimed at investigating the effect of the COVID-19 pandemic on hospital admissions for stroke. METHODS We conducted a retrospective observational study to determine if there was a significant difference in the number of hospital admissions for stroke during the 2 months of lockdown and the two preceding months, (starting on 24 March 2020). The numbers were also compared with the figures during the same months in the previous year. The numbers were also compared to the same months one year prior. The secondary objectives were to compare the time between the onset of stroke and presentation to the hospital, type of strokes that presented to the hospital, severity of stroke, number of code activations, number of thrombolysis conducted, and in-hospital mortality between the same time periods. RESULTS The total number of patients admitted for stroke during the time periods from 25th March 2019 to 24th May 2019, 25th January 2020 to 24th March 2020 and 25th March 2020 to 24th May 2020 were 82, 72 and 75 respectively, and there was no statistically significant difference between these numbers. However, there was a significant increase in the proportion of stroke cases when compared to total hospital admissions. This suggests that an increase in stroke incidence may have been masked by a reduction in the total number of patients presenting to the hospital. The National Institutes of Health Stroke Scale (NIHSS) score of the patients who presented during the lockdown were higher. There were no significant differences in the time between the onset of stroke and presentation to the hospital, type of strokes that presented to the hospital, severity of stroke, number of code activations, number of thrombolysis conducted, and in-hospital mortality between the periods under study. CONCLUSIONS The present study suggests that there may be a relative increase in the incidence of stroke in the community, as a result of the COVID-19 pandemic. The patients who presented with stroke during the lockdown period had a higher NIHSS score. KEYWORDS COVID-19, Stroke, Lockdown