Stroke-related hospital admissions during COVID-19 pandemic in the latin american stroke registry (lase)

Background: COVID-19 pandemic has forced important changes in health care worldwide Stroke care networks have been affected, especially acute admissions and ancillary tests availability We assessed the impact of the pandemic and the lockdowns imposed in stroke admissions in Latin America Methods: A multinational study (7 countries, 18 centers) of patients admitted since the pandemic outbreak (January - June 2020) These cases were compared with the same period in 2019 We also assessed patterns during the strictest lockdown period (March-June 2020) Number of cases, stroke etiology and severity, acute care and functional outcomes were compared per periods, months, centers and countries Results: There were 1863 stroke cases in 2019 and 1781 cases in 2020 (p=0 02) We found a significant increase in strokes of undetermined etiology due to incomplete studies in 2020 [16 8% vs 27 6%, p<0 001]) Most countries reported decreases in all-type stroke admissions, except Mexico and Brasil (16% and 36% increases in admissions, respectively) There were no significant differences among months All-type mortality increased (6 2% vs 12 6%, p<0 001), and poor functional outcome (mRs 3-6) increased from 32 2% to 38 8% (p=0 007) in 2020 During the period of strict lockdown (March-June 2020), ischemic stroke admissions during the first 24 hours of onset (68 3% vs 64 4%, p=0 1) and in-hospital stroke code activation (35 1% vs 27 6%, p=0 005) diminished compared to 2019 period No differences in total reperfusion treatment rates were observed, with similar door-to-needle and door-to-groin times in both periods Conclusions: All-type stroke admissions diminished only slightly during the first months of the COVID-19 pandemic However, in this region, we found substantial deficiencies in stroke work-up, poor short-term outcome and increased mortality