Stroke Codes during the COVID-19 Pandemic: Clinical Characteristics

Abstract

Background and Purpose:The COVID-19 pandemic has affected stroke care delivery. New triage systems have affected the code stroke process and lead to longer treatment times. We aimed to describe the clinical features of stroke during the pandemic and its' effect on the code stroke process.Methods: A descriptive, non-experimental, cross-sectional study was conducted in all stroke codes between March 1, 2020, and June 30, 2020. Demographic data, vascular risk factors, clinical symptoms (both neurological and respiratory), clinical exam finding, COVID-19 screening score, final clinical diagnosis, and use of thrombolytics and COVID-19 PCR results were collected. Chi-square, Fisher's exact test, Student's t-test, and the Mann-Whitney U test were used to compare the demographics and clinical characteristics between COVID-19 positive and negative patients.Results: Of 202 code strokes, 14% were COVID-19 positive. Fortyfive percent of stroke codes were diagnosed with stroke or transient ischemic attack. COVID-19 patients were on average 5 years younger. Stroke code rates dropped in March 2020 compared to 2019, then increased gradually. COVID-19 positive patients were more likely to present with symptoms and signs suggestive of large vessel disease. Respiratory symptoms (fever, cough, and shortness of breath) were more likely to be seen in COVID-19 positive patients. The COVID-19 triage checklist score was higher in the COVID-19 positive patients (5.7 vs 3.7). A checklist score of 4 or less was seen in 32% of COVID-19 positive patients compared to 52% of COVID-19 negative patients. Fourteen percent of stroke or transient ischemic attack (TIA) vs no stroke or TIA were COVID-19 positive. A deviation of trend in stroke code activation for non-citizens was observed.