P-031 Effect of COVID-19 on acute ischemic stroke: population-level experience

IntroductionSeveral studies report substantial decreases in the volume of acute ischemic stroke (AIS) during the early stage of coronavirus disease 2019 (COVID-19) pandemic. Differences in characteristics of strokes such as increasing rates of large vessel occlusion (LVO) stroke were also observed comparing between pre-COVID and COVID eras. However, these findings were often based on data from selected hospitals or networks and estimates may be biased by level of stroke care and baseline case mix. A population-based study including rural hospitals and non-stroke centers covering a longer observation period beyond the early-pandemic epoch may lead to more accurate insights.MethodsWe conducted a retrospective population-based study using the Texas Inpatient Public Use Data File, capturing all discharges from hospitals in the State of Texas excluding federal hospitals. We assessed quarterly changes in volume, characteristics, care of AIS, and patient outcomes from April 1, 2019-June 30, 2020 and compared two time periods. 2020Q2 was defined as the pandemic period and the previous one year as the pre-pandemic period. Cases were defined as inpatient hospitalizations to acute care hospitals with a primary diagnosis of AIS. ICD-10 diagnosis and procedure codes were used to identify AIS, LVO, use of intravenous tissue plasminogen activator (IV-tPA) and endovascular treatment (EVT). Hospitals were determined as CSC (Comprehensive Stroke Center) and non-CSC based on designation by the Texas Department of State Health Services.ResultsThe number of AIS cases dropped substantially from 10,745 per quarter in the pre-pandemic period to 9,277 in the pandemic period (-14%) in Texas. The percentage of patients aged younger than 65 (39.0% vs 40.4%, p=0.014) and LVO stroke (30.0% vs 32.7%, p<0.001) slightly increased. Percentages of admission to CSC (39.1% vs 39.5%, p=0.57) and admission through inter-hospital transfer (9.6% vs 9.3%, p=0.35) remained similar between pre-pandemic and pandemic periods. There was also no significant change in the use of IV-tPA (14.1% vs 13.6%, P=0.20) or EVT (5.4% VS 5.8%, P=0.12). In-hospital mortality slightly increased from 2.9% to 3.2% but it was not statistically significant (p=0.13). However, the percentage of death or hospice discharge increased from 7.6% to 8.4% (p=0.003) and age and LVO type adjusted odds ratio was 1.13 (95% CI 1.04-1.23).Abstact P-031 Figure 1ConclusionIn this population-level study, significant decreases in AIS volume were observed with slightly higher incidence in younger population and higher LVO strokes. Rates of thrombolysis and thrombectomy remained unchanged but patients appeared to have worse outcomes.DisclosuresY. Kim: None. S. Khose: None. S. Salazar-Marioni: None. R. Abdelkhaleq: None. S. Sheth: None.