Geography not a factor in 2020 stroke consults;a telestroke experience during the COVID19 pandemic

Introduction: The COVID19 pandemic causes strokes in younger patient populations with higher deficits We examined recent numbers of stroke consults, their age and deficits in a large telestroke program and compared them to 2019 Hypothesis: Increased younger stroke consults in 2020 would involve higher deficits associated with COVID19 Methods: The Institute for Digital Health & Innovation-Stroke Program provides neurology support to 54 spoke hospitals across Arkansas Stroke consults who received Alteplase during 01/01/20 to 07/31/20 were compared to the same months in 2019 Retrospective analysis included consult age, geographical region, mechanical thrombectomy (MT), deficits (initial and post NIHSS) and outcomes Age was listed as /=65 yrs The state was blocked into seven geographical regions MT was noted and deficits as improved, worsened, same (no improvement) or unknown COVID19 positivity was unknown Results: Consult numbers declined in 2020 vs 2019, 285 vs 370, respectively Both years saw MT in approximately 10%;however, 27% went to hospice or expired in 2020 vs 7 7% in 2019 In 2020 and 2019, those /= 65 years were not different between years(p=0 61);however, age had a similar significant effect on the initial NIHSS in both 2019 and 2020 (X2=13 5,n=370,p=0 0037 and X2=10 8,n=285,p=0 012, respectively) Improvement in initial deficit scores did not change (X2=6 9,n=655,p=0 074) No geographical differences were seen (p=0 66) Monthly initial deficits indicated a significant peak risein the younger consults (< 65) in April 2020 Conclusion: Stroke consult numbers declined by 13% in 2020 but the proportion of young and oldwere unchanged In April 2020, younger consults (< 65) experienced a spike in deficits Furtherevaluation throughout 2020 is warranted as COVID19 cases spread