Frontiers in Neurology (Feb 2021)

COVID-19 Pandemic Impact on Care for Stroke in Australia: Emerging Evidence From the Australian Stroke Clinical Registry

  • Dominique A. Cadilhac,
  • Dominique A. Cadilhac,
  • Joosup Kim,
  • Joosup Kim,
  • Emma K. Tod,
  • Julie L. Morrison,
  • Sibilah J. Breen,
  • Katherine Jaques,
  • Rohan Grimley,
  • Rohan Grimley,
  • Brett Jones,
  • Geoffrey C. Cloud,
  • Geoffrey C. Cloud,
  • Timothy Kleinig,
  • Susan Hillier,
  • Helen Castley,
  • Richard I. Lindley,
  • Natasha A. Lannin,
  • Natasha A. Lannin,
  • Sandy Middleton,
  • Sandy Middleton,
  • Bernard Yan,
  • Kelvin Hill,
  • Benjamin B. Clissold,
  • Benjamin B. Clissold,
  • Peter J. Mitchell,
  • Craig S. Anderson,
  • Craig S. Anderson,
  • Steven G. Faux,
  • Steven G. Faux,
  • Bruce C. V. Campbell,
  • Bruce C. V. Campbell,
  • The AuSCR COVID-19 Reporting Consortium Group

DOI
https://doi.org/10.3389/fneur.2021.621495
Journal volume & issue
Vol. 12

Abstract

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We present information on acute stroke care for the first wave of the COVID-19 pandemic in Australia using data from the Australian Stroke Clinical Registry (AuSCR). The first case of COVID-19 in Australia was recorded in late January 2020 and national restrictions to control the virus commenced in March. To account for seasonal effects of stroke admissions, patient-level data from the registry from January to June 2020 were compared to the same period in 2019 (historical-control) from 61 public hospitals. We compared periods using descriptive statistics and performed interrupted time series analyses. Perceptions of stroke clinicians were obtained from 53/72 (74%) hospitals participating in the AuSCR (80% nurses) via a voluntary, electronic feedback survey. Survey data were summarized to provide contextual information for the registry-based analysis. Data from the registry covered locations that had 91% of Australian COVID-19 cases to the end of June 2020. For the historical-control period, 9,308 episodes of care were compared with the pandemic period (8,992 episodes). Patient characteristics were similar for each cohort (median age: 75 years; 56% male; ischemic stroke 69%). Treatment in stroke units decreased progressively during the pandemic period (control: 76% pandemic: 70%, p < 0.001). Clinical staff reported fewer resources available for stroke including 10% reporting reduced stroke unit beds. Several time-based metrics were unchanged whereas door-to-needle times were longer during the peak pandemic period (March-April, 2020; 82 min, control: 74 min, p = 0.012). Our data emphasize the need to maintain appropriate acute stroke care during times of national emergency such as pandemic management.

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