Abstract P109: Geography Not a Factor in 2020 Stroke Consults; A Telestroke Experience During the Covid19 Pandemic

Introduction: The COVID19 pandemic causes strokes in younger patient populations with higher deficits. We examined recent numbers of stroke consults, their age and deficits in a large telestroke program and compared them to 2019 Hypothesis: Increased younger stroke consults in 2020 would involve higher deficits associated with COVID19. Methods: The Institute for Digital Health & Innovation-Stroke Program provides neurology support to 54 spoke hospitals across Arkansas. Stroke consults who received Alteplase during 01/01/20 to 07/31/20 were compared to the same months in 2019. Retrospective analysis included consult age, geographical region, mechanical thrombectomy (MT), deficits (initial and post NIHSS) and outcomes. Age was listed as < 65 or >/=65 yrs. The state was blocked into seven geographical regions. MT was noted and deficits as improved, worsened, same (no improvement) or unknown. COVID19 positivity was unknown. Results: Consult numbers declined in 2020 vs. 2019, 285 vs. 370, respectively. Both years saw MT in approximately 10%; however, 27% went to hospice or expired in 2020 vs. 7.7% in 2019. In 2020 and 2019, those < 65 consults who received MT were similar at 37 and 41% of total procedures, respectively. Pre-pandemic, there were significant differences in consult numbers among the seven regions (X2=30.1,n=370,p=0.037) in 2020, there were none (p=NS). The number of consults < 65 or >/= 65 years were not different between years(p=0.61); however, age had a similar significant effect on the initial NIHSS in both 2019 and 2020 (X2=13.5,n=370,p=0.0037 and X2=10.8,n=285,p=0.012, respectively). Improvement in initial deficit scores did not change (X2=6.9,n=655,p=0.074). No geographical differences were seen (p=0.66). Monthly initial deficits indicated a significant peak rise in the younger consults (< 65) in April 2020. Conclusion: Stroke consult numbers declined by 13% in 2020 but the proportion of young and old were unchanged. In April 2020, younger consults (< 65) experienced a spike in deficits. Further evaluation throughout 2020 is warranted as COVID19 cases spread.