| Abstrakt: |
Introduction:Stroke is a medical emergency requiring prompt evaluation and treatment. COVID-19 disproportionally burdened certain socioeconomic groups and its impact on patient's hospital arrival and access to emergency services to treat stroke is unknown. This study examines whether there was an impact of patient characteristics and COVID-19 on last known well (LKW) to arrival.Methods:Data from our health system stroke registry comprised of 40 hospitals were used for the analysis. Patients with a diagnosis of Ischemic stroke (ISC) or Intracerebral Hemorrhage (ICH) discharged between Jan 1 2018 - Mar 15 2020 (pre-COVID) and Mar 16 2020 - Apr 10 2022 (pandemic period) were included in the analysis. Inpatient strokes were excluded. Multinomial logistic regression was used to determine the likelihood of presenting to the hospital in the hyperacute phase (<4.5 hours) and the acute phase (4.5 to 24 hours) compared to delayed phase (> 24 hours), adjusting for COVID-19 time period, race/ethnicity, mode of arrival, insurance type, stroke type, age, NIHSS at admit, and medical history.Results:A total of 25,102 patients were included in the analysis, of which 55.7% arrived in hyperacute phase, 37.7% acute phase, and 6.6% delayed phase. ICH patients (AOR 1.10, 95% CI 1.03, 1.18) were more likely than ISC patients to arrive in the hyperacute phase than delayed phase. Asian patients were less likely than white patients to arrive in the hyperacute phase (AOR 0.72, 95% CI 0.58, 0.88) than delayed phase. Patients with a history of dementia (AOR 1.69, 95% CI 1.05, 2.72), depression (AOR 1.19, 95% CI 1.02, 1.39), and afib/flutter (AOR 1.31, 95% CI 1.12, 1.53) were more likely to arrive in the hyperacute phase than delayed phase. Patients with history of diabetes (AOR 0.69, 95% CI 0.61, 0.77), smoking (AOR 0.71, 95% CI 0.60, 0.83) and drug/alcohol abuse (AOR 0.62, 95% CI 0.52, 0.75) were less likely to arrive in the hyperacute phase than delayed phase. COVID-19 time period, history of stroke, and insurance had no impact on time to arrival.Conclusions:While several patient characteristics and medical comorbidities were significantly associated with delay in arrival of stroke patients, the first two years into COVID-19 was not associated with delay in presentation. |
