Impact of the 2019 Coronavirus Infectious Disease (COVID-19) pandemic on onset to door time and admissions of new onset acute ischemic stroke in a tertiary care level hospital in North India.

Abstract

Coronavirus infectious disease (COVID-19) pandemic disrupted the already marginalized healthcare provision in resource limited countries like India. This study compared onset to door time and temporal trends of admissions to seek medical care in new onset acute ischaemic stroke during the COVID-19 period with a representative pre-COVID-19 period in rural background. Prospective Cross-sectional study in a tertiary level hospital in North India. Study included new onset acute ischaemic stroke admitted within first 2 weeks of symptoms onset. Subjects were divided into: Group A - Pre-COVID-19 stroke, Group B - Non-COVID-19 Stroke, and Group C - Stroke, positive for COVID-19. Detailed epidemiological, clinical profile, onset to door time and temporal trends of admissions were recorded. Chi square/Fisher's exact test and Independent Samples T test or Mann-Whitney U test were used for categorical and continuous variables. Onset to door time in new onset acute ischaemic stroke was significantly prolonged by 6 h in COVID-19 period (median (interquartile range), 19 (12-27) h) as compared with pre-COVID-19 period. Admissions of new onset acute ischaemic stroke were significantly less in COVID-19 period. Comorbidities and severity of stroke (mean National Institutes of Health Stroke Scale, 20 ± 4) were more during the COVID-19 period. Incidence and mortality of COVID-19 positive new onset acute ischaemic stroke were 0.95% and 38%. Onset to door time in new onset acute ischaemic stroke was significantly prolonged in COVID-19 as compared with pre-COVID-19 period. The admissions were fewer with more severity and comorbidities in COVID-19 period. COVID-19 positive stroke patients had more severity and mortality as compared with non-COVID-19 stroke.