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

Sulena; Urvashi Kataria; Rajat Bhatt; Ashish Sharma; Hobinder Arora; Himanshu Kaushal

doi:10.4103/jfmpc.jfmpc_2398_21

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

J Family Med Prim Care. 2022 Jun;11(6):3217-3223. doi: 10.4103/jfmpc.jfmpc_2398_21. Epub 2022 Jun 30.

Authors

Sulena¹, Urvashi Kataria², Rajat Bhatt³, Ashish Sharma⁴, Hobinder Arora², Himanshu Kaushal³

Affiliations

¹ Department of Neurology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
² Department of Community Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
³ Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
⁴ Department of Neurology, AIIMS Bilaspur, Himachal Pradesh, India.

Abstract

Context: Coronavirus infectious disease (COVID-19) pandemic disrupted the already marginalized healthcare provision in resource limited countries like India.

Aims: 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.

Settings and design: Prospective Cross-sectional study in a tertiary level hospital in North India.

Methods and material: 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.

Statistical analysis used: Chi square/Fisher's exact test and Independent Samples T test or Mann-Whitney U test were used for categorical and continuous variables.

Results: 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%.

Conclusions: 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.

Keywords: 2019 coronavirus infectious disease; COVID and stroke; COVID-19; acute ischaemic stroke; new onset acute ischaemic stroke; onset to door time.