Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital

Objective To evaluate the impact of the lockdown measures, consequent to the outbreak of COVID-19 pandemic, on the quality of pre-hospital and in-hospital care of patients with acute ischemic stroke. Methods This is an observational cohort study. Data sources were the clinical reports of patients admitted during the first month of lockdown and discharged with a confirmed diagnosis of stroke or TIA. Data were collected in the interval ranging from March 11th to April 11th 2020. As controls, we evaluated the clinical reports of patients with stroke or TIA admitted in the same period of 2019. Results The clinical reports of patients eligible for the study were 52 in 2020 (71.6 +/- 12.2 years) and 41 in 2019 (73.7 +/- 13.1 years). During the lockdown, we observed a significant increase in onset-to-door time (median = 387 vs 161 min,p = 0.001), a significant reduction of the total number of thrombolysis (7 vs 13,p = 0.033), a non-significant increase of thrombectomy (15 vs 9,p = 0.451), and a significant increase in door-to-groin time (median = 120 vs 93 min,p = 0.048). No relevant difference was observed between 2019 and 2020 in the total number of patients admitted. Conclusions Due to the COVID-19 pandemic and lockdown measures, the stroke care pathway changed, involving both pre-hospital and in-hospital performances.