Changes In Stroke Patient'S Health-Seeking Behavior By Covid-19 Epidemic Regions : Data From Korean Stroke Registry

Background and purpose: With the wide spread of coronavirus disease 2019 (COVID-19) around the world, not only patients with COVID-19, but also patients with other disease such as stroke have undergone many changes in their health-seeking behavior Between late February and March 2020, COVID-19 was epidemic in the community of Daegu city and Gyeongsangbuk-do region (D-G region) in Korea We aimed to clarify the changes in the health-seeking behaviors of stroke patients and stroke care services by region in Korea through analysis of data from Korean Stroke Registry (KSR) Methods: We retrospectively reviewed the data with acute stroke and transient ischemic attack (TIA) patients between 2019 and 2020 We compared the stroke onset to hospital arrival (onset-todoor) time of these patients in the D-G region and other regions in Korea during the epidemic period in 2020 (post-COVID-19: February 18-March 31, 2020) and the same period in 2019 (Pre-COVID- 19) In addition, we investigated the in-hospital stroke pathways with the patients Results: 1,792 patients in pre-COVID-19 and 1,555 patients in post-COVID-19 who visited KSRregistered hospitals were analyzed Compared to pre-COVID-19, the number of patients registered in KSR decreased in most regions in post-COVID-19 In the D-G region, the number of registered patients decreased by two thirds, and the proportion of patients with TIA decreased significantly (9 97% to 2 91%) Unlike other regions, the median onset-to-door time increased significantly in the D-G region (361 versus 526 5 minutes, p=0 0084) The proportion of patients with onset-to-door time within 3 hours also decreased significantly (36 45% versus 28 16%, p=0 0485) Patients in their 60s and 70s and mild symptoms (NIHSS score 0 to 3) came to the hospital later As a result, the patients who underwent thrombectomy also decreased, but the treatment time did not differ between the two periods Conclusion: During the epidemic of COVID-19, the patients residing in the epicenter showed distinct changes in health-seeking behavior Appropriate public education about stroke is needed during the COVID-19 pandemic