Stroke Care During the COVID-19 Pandemic

Background: The SARS-CoV-2 pandemic led to substantial changes in the allocation of healthcare resources and affected the behavior of patients experiencing stroke symptoms. Previous studies have mainly focused on the so-called "first wave" of the pandemic during the first half of 2020. During this period, the number of hospital admissions of patients with transient ischemic attacks (TIAs) and minor strokes decreased significantly in many hospitals. This reduction was attributed not only to the reallocation of healthcare resources toward the care of patients with COVID-19, but also to patients' concerns about becoming infected with SARS-CoV-2 during a hospital stay. Since then, the situation has changed, as hospitals have become better prepared to treat patients with COVID-19 and the public has become better informed about the risks of SARS-CoV-2 infection. It is therefore possible that the pattern of acute stroke care during the subsequent wave of COVID-19, which began in autumn 2020, differed from that observed during the first wave.

Aim: The aim of this project is to analyze changes in patterns of acute stroke care across different regions of Europe during the first and subsequent waves of the COVID-19 pandemic and to identify epidemiological determinants associated with changes in stroke care.

Methods: We will collect and analyze data on hospital admissions of patients with acute ischemic stroke, hemorrhagic stroke, and transient ischemic attacks (TIAs) from approximately 40 participating stroke units across Europe for the period from January 1, 2019, to June 30, 2021.

The following parameters will be collected:

Number of hospital admissions per month and mean length of hospital stay (LOS) per month from January 1, 2019, to June 30, 2021, for the following diagnoses:

ischemic stroke hemorrhagic stroke transient ischemic attack Monthly numbers of thrombolysis and thrombectomy procedures during the same period.

Epidemiological parameters: population density, population age, geography of the region, urban/rural region properties, traffic connection to the first European hot spot of Covid-19, number of nursing homes Care characteritics: hospital size, stroke unit capacity.

Statistical analysis: Changes in the number of stroke admissions and length of hospital stay, as well as rates of thrombolysis and thrombectomy, will be analyzed in relation to regional COVID-19 incidence and mortality rates and other epidemiological parameters, including epidemiological connectivity to the first European COVID-19 hotspot.

Expected outcomes: We aim to identify regional patterns of change in acute stroke care during different phases of the COVID-19 pandemic and to determine epidemiological factors associated with these changes.