Acute stroke admission at a district hospital in lisbon during the pandemic: Initial impact and adaptation of the services

Background and Aims: Several studies reported falls in stroke admissions during the pandemic, for reasons like fear of contracting COVID-19, governmental stay-at-home orders and overstretched emergency services. The Loures region has been particularly affected by this pandemic, with our institution having some of the highest numbers of SARSCoV-2 hospitalized patients in the Lisbon Metropolitan Area. This study aims to evaluate the impact of the pandemic on acute stroke admissions and care during the first six months of the pandemic and, more recently, during its second wave. Methods: Retrospective and comparative analysis of all acute stroke imaging protocol cases at our institution over two homologous 9-month periods: 1/04-31/12, 2019 and 1/4-31/12, 2020. Parameters evaluated were time from symptom onset to presentation, demographics, NIHSS, acute CT findings, number of IV thrombolysis, transfers for MT. The same analysis is also presented for the first trimester of 2021. Results: There was a 10% reduction in suspected acute stroke CT studies (283 in Ap-Dec 2019, 252 in 2020). It took patients 30% longer to get to the hospital and there was a statistically significant decrease in average ASPECTS. Around 7% less were eligible for IVT and there was a 20% reduction of patients with LVO transferred for MT. The mRS at discharge was slightly worse. These changes have been attenuated in the first trimester of 2021 (preliminary data). Conclusions: There was a significant impact on acute stroke care caused by the pandemic. Services must adapt to be able to provide the same quality of care even during epidemic waves.