Page 32 - Delaware Medical Journal - January/February 2021
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The Shadow Epidemic: COVID-19 and Stroke in Delaware’s Only Comprehensive Stroke Center Sridhara S. Yaddanapudi, MD; Kim Gannon, MD, PhD; Sudhakar R. Satti, MD, FAHA
INTRODUCTION
Acute ischemic stroke is a medical emergency. Any delay in treatment reduces the chance of disability-free survival and increases risk of death
(in severe cases). A June 2020 Journal
of the American Medical Association (JAMA) correspondence by Woolfe et
al found that mortality secondary to increased when comparing January-May of 2019 to the same period in 2020.1 Globally and nationally during the COVID-19 pandemic, patients have been more reluctant to present to the hospital, either via emergency services or directly to the emergency department, for acute stroke symptoms. Fear of contracting the virus has resulted in fewer patients being evaluated for mild to moderate strokes and contributed to delays in treatment, potentially resulting in lower rates of administration of IV alteplase and patients undergoing mechanical thrombectomy for large vessel occlusions.
We sought to determine the impact
of COVID-19 on stroke services at ChristianaCare, the only comprehensive stroke center in Delaware. Although the around December 1, 2019,2 the exact date when COVID-19 began to affect patients
in our geography is unknown. A statewide emergency was issued March 12, 2020
in Delaware. Beginning March 16, 2020, public gatherings were restricted to fewer than 50 people and restaurants were closed for indoor/outdoor dining. On March 23, 2020, all non-essential businesses, except those offering goods and services, were ordered to close, and a shelter-in-place order was passed for all Delaware residents. Self- quarantine for out-of-state travelers was declared on March 29, 2020. Face masks began to be required in public settings where social distancing was not possible, such as public transit, grocery stores, and pharmacies, on April 25, 2020. Reopening of the state began as a phased process on May 14, 2020 with the reopening of certain beaches and limited on-premise businesses.
The primary goal of this study was to evaluate the impact during COVID-19
on presentation to the emergency department for stroke-like symptoms. Secondary data points included radiology utilization, rates of alteplase delivery
(IV tPA), and rates of mechanical thrombectomy for large vessel occlusion.
METHODS
activation of the stroke team (neurologist, neurocritical care physician, and radiology team) when a patient arrives with stroke- like symptoms. We did not differentiate the population arriving by personal vehicle versus emergency response services. presenting with symptoms of an acute ischemic stroke who receive alteplase.
To compare stroke alerts, stroke codes, and
2019 and 2020, we plotted monthly tallies, and reviewed statistical difference based on daily averages for the number of days per month. The study data included a count of cases over time in months, and the numbers of stroke alerts, codes, and mechanical thrombectomy were compared.
as a comparator. We compared the epidemiological weeks from 2019 and 2020, which allowed for matching in the years
to account for any seasonal variations.
Data was gathered from our internal stroke registry, which is updated on a rolling basis.
After a state emergency order for COVID-19 was put into place in Delaware on March 16, 2020, we saw a
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Del Med J | January/February 2021 | Vol. 93 | No. 1
