COVID-19 Pandemic Impact on Care for Stroke in Australia: Emerging Evidence From the Australian Stroke Clinical Registry

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Cadilhac, DA
Kim, J
Tod, EK
Morrison, JL
Breen, SJ
Jaques, K
Grimley, R
Jones, B
Cloud, GC
Kleinig, T
Hillier, S
Castley, H
Lindley, RI
Lannin, NA
et al.
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We present information on acute stroke care for the first wave of the COVID-19 pandemic in Australia using data from the Australian Stroke Clinical Registry (AuSCR). The first case of COVID-19 in Australia was recorded in late January 2020 and national restrictions to control the virus commenced in March. To account for seasonal effects of stroke admissions, patient-level data from the registry from January to June 2020 were compared to the same period in 2019 (historical-control) from 61 public hospitals. We compared periods using descriptive statistics and performed interrupted time series analyses. Perceptions of stroke clinicians were obtained from 53/72 (74%) hospitals participating in the AuSCR (80% nurses) via a voluntary, electronic feedback survey. Survey data were summarized to provide contextual information for the registry-based analysis. Data from the registry covered locations that had 91% of Australian COVID-19 cases to the end of June 2020. For the historical-control period, 9,308 episodes of care were compared with the pandemic period (8,992 episodes). Patient characteristics were similar for each cohort (median age: 75 years; 56% male; ischemic stroke 69%). Treatment in stroke units decreased progressively during the pandemic period (control: 76% pandemic: 70%, p < 0.001). Clinical staff reported fewer resources available for stroke including 10% reporting reduced stroke unit beds. Several time-based metrics were unchanged whereas door-to-needle times were longer during the peak pandemic period (March-April, 2020; 82 min, control: 74 min, p = 0.012). Our data emphasize the need to maintain appropriate acute stroke care during times of national emergency such as pandemic management.

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Frontiers in Neurology
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© 2021 Cadilhac, Kim, Tod, Morrison, Breen, Jaques, Grimley, Jones, Cloud, Kleinig, Hillier, Castley, Lindley, Lannin, Middleton, Yan, Hill, Clissold, Mitchell, Anderson, Faux, Campbell and the AuSCR COVID-19 Reporting Consortium Group. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Cadilhac, DA; Kim, J; Tod, EK; Morrison, JL; Breen, SJ; Jaques, K; Grimley, R; Jones, B; Cloud, GC; Kleinig, T; Hillier, S; Castley, H; Lindley, RI; Lannin, NA; Middleton, S; Yan, B; Hill, K; Clissold, BB; Mitchell, PJ; Anderson, CS; Faux, SG; Campbell, BCV, COVID-19 Pandemic Impact on Care for Stroke in Australia: Emerging Evidence From the Australian Stroke Clinical Registry, Frontiers in Neurology, 2021, 12, pp. 621495