Changes in prehospital stroke care and stroke mimic patterns during the covid-19 lockdown

Melaika K. Sveikata L. Wiśniewski A. Jaxybayeva A. Ekkert A. Jatužis D. Masiliūnas R.
2 February 2021 MDPI AG

International Journal of Environmental Research and Public Health
2021 #18 Issue 4 1 - 11 pp.

The impact of COVID-19 lockdown on prehospital stroke care is largely unknown. We aimed to compare stroke care patterns before and during a state-wide lockdown. Thus, we analysed prospective data of stroke alerts referred to our stroke centre between 1 December 2019 and 16 June 2020, and compared them between two periods—15 weeks before and 13 weeks during the state-wide lockdown declared in Lithuania on 16 March 2020. Among 719 referrals for suspected stroke, there was a decrease in stroke alerts (rate ratio 0.61, 95% CI (0.52–0.71)), stroke admissions (0.63, 95% CI (0.52–0.76)), and decrease in prehospital stroke triage quality (positive predictive value 72.1% vs. 79.9%, p = 0.042) during the lockdown. The onset-to-door time was longer (153.0 vs. 120.5 min, p = 0.049) and seizures and intracranial tumours were more common among stroke mimics (16.9% vs. 6.7%, p = 0.012 and 9.6% vs. 3.0%, p = 0.037, respectively). We conclude that there was a decline in prehospital stroke triage quality during the lockdown despite low COVID-19 incidence in the country. Moreover, we observed an increase in hospital arrival delays and severe conditions presenting as stroke mimics. Our findings suggest that improved strategies are required to maintain optimal neurological care during public health emergencies.

COVID-19 , Emergency medical services , Misdiagnosis , Stroke , Stroke mimic , Triage

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Faculty of Medicine, Vilnius University, Vilnius, 03101, Lithuania
J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, 02109, MA, United States
Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, 50161, Lithuania
Department of Neurology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, 85-094, Poland
Department of Neurology, Astana Medical University, Nur-Sultan, 010000, Kazakhstan
Center of Neurology, Vilnius University, Vilnius, 08661, Lithuania

Faculty of Medicine
J. Philip Kistler Stroke Research Center
Institute of Cardiology
Department of Neurology
Department of Neurology
Center of Neurology

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