Change in stroke presentations during COVID-19 pandemic in South-Western Sydney

  1. James Thomas
  2. David Manser
  3. Peter Thomas
  4. Nicholas Moore
  5. Paul Middleton
  6. Dennis Cordato
  7. Cecilia Cappelen-Smith
  8. Alan McDougall

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Abstract

Background

Australia managed relatively well during the global COVID-19 pandemic owing to our swift mandated public health response. During the NSW lockdown restrictions, we noted a decrease in acute stroke presentations at our institution, similar to what was subsequently reported worldwide.

Aims

We aimed to test our hypothesis that (i) the true numbers of ischaemic strokes did not change, however patients were presenting later and (ii) the proportion of TIAs decreased.

Methods

We conducted a retrospective audit of all stroke and TIA presentations in 2020 and compared these with data from 2019. We collected information about stroke subtype, severity, time from stroke/TIA onset to presentation and acute reperfusion therapies.

Results

Between January-February and April-March 2020, there was a 15% drop in acute stroke presentations (128 vs. 109). In the same period “stroke mimic” presentations dropped by 22%. The proportion of patients attending the emergency department within 4.5hrs was only 36% compared with 48% over the similar period in 2019.

Conclusions

Although the raw numbers of ischemic stroke presentations remained stable during NSW Covid lockdown, the proportion of patients presenting within time window for acute reperfusion therapies fell. The number of TIAs similarly fell suggesting COVID-19 discouraged patients from presenting to hospital which placed them at higher risk of disabling stroke. The opportunity cost of lockdown restrictions on stroke outcome should be considered in future policy directives.

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  1. ScreenIT

    SciScore for 10.1101/2022.05.02.22274456: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Another limitation of our study is that it was underpowered to identify significant differences in the stroke subgroups due to low numbers of strokes in a relatively short period of lockdown. New South Wales is currently in the middle of a period of significant increase in COVID-19 transmission due to a local outbreak of the delta strain of the virus in Western and South Western Sydney. We plan to repeat our analysis on the new time period in order to increase our statistical power strengthen our results.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.05.02.22274456v1 on medRxiv