Throughout the 2020 pandemic, advice from medical professionals has allied with admonitions from state authorities that individuals should “shelter in place.”
The heightened limitations on medical clinics and hospital access, lockdowns on travel, social distancing, and nursing home quarantines are externally imposed orders from state and local governments… all of which may be causing hesitation to seek emergency treatment even though doing so could potentially uncover a stroke diagnosis. To the layman, the following may be cause for alarm: “patients are likely to prioritize avoiding exposure to SARS-CoV-2 over addressing what they may perceive as mild symptoms of headache, lethargy, difficulty speaking, and numbness.”
The World Health Organization has noted the decrease in stroke presentations over the past several months, however, whether this is directly due to widespread fear of contracting COVID-19 or a conscientious intention to comply with shelter-in-place policies is undetermined.
Based on a statistically unusual decrease observed by physicians directly, it may be that Coronavirus in general is discouraging patients from seeking in-patient care or emergency department help when stroke symptoms arise. In their JMIR article, “Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?” Adrienne Nicole Dula, Gretchel Gealogo Brown, Aarushi Aggarwal, and Kal L Clark reviewed the evidence surrounding the precipitous drop in ED visits by TIA and ischemic stroke victims in their region of practice, Travis County, TX. They describe how patients are known to misinterpret stroke symptoms or assume that the symptoms resolve without intervention, and often delay seeking clinical or urgent care. In light of this, they sought to comprehensively evaluate the impact of ongoing lockdown restrictions and patient trepidation (viz. social caution) on both incidence and severity of ischemic stroke.
As they describe it, many symptoms of a stroke are noticed by a family member or friends. Stroke symptoms may be currently advancing unobserved (and without stroke diagnosis) due to the loss of interpersonal contact and normal societal interactions. Individuals who would normally present to the emergency department may be staying home because there is no one to notice that they seem out of sorts. Data show that pre-pandemic (2/1/20 thru 2/29/20), the state of Texas had a mean of 63.3 patients per day), and in the early pandemic (3/26 through 4/8/20), the mean was 43.1 patients per day, representing a decrease of 31.8%. The natural conclusion to draw from a decrease of almost a third of normal patient flow is that people are not seeking treatment when stroke diagnosis may be imminent.
BrainCheck assessment and Stroke Diagnoses
It is ever more essential that clinics/ physicians assess cognitive function before there’s even a hint of stroke symptoms. A baseline comparison will only be available for your patients if they are assessed prior to ischemic events: take steps to build a medical record that ED physicians can utilize during symptomatic presentation. Patients and their families are less likely than ever to detect symptoms, and establishing a baseline for cognitive function, uncovering cognitive impairment, requires an assessment protocol that is easy to administer and fully reimbursable.
Providers should regularly assess cognitive function to track progression and to create a comprehensive plan for care.
Contact BrainCheck for a free trial of our platform to learn how easy it is to implement an assessment regimen for your practice.