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Brief report
Decline in stroke alerts and hospitalisations during the COVID-19 pandemic
  1. Malveeka Sharma1,
  2. Vasileios-Arsenios Lioutas2,
  3. Tracy Madsen3,
  4. Judith Clark4,
  5. Jillian O'Sullivan2,
  6. Mitchell S. V. Elkind5,6,
  7. Joshua Z. Willey5,
  8. Randolph S. Marshall5,
  9. Magdy H. Selim2,
  10. David Greer4,
  11. David L. Tirschwell1,
  12. Tina Burton7,
  13. Amelia Boehme5,6,
  14. Hugo J. Aparicio4
  1. 1 Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
  2. 2 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Deparment of Emergency Medicine, Brown University, Providence, Rhode Island, USA
  4. 4 Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5 Department of Neurology, Vagelos College of Physicians and Surgeon, Columbia University, New York, New York, USA
  6. 6 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
  7. 7 Department of Neurology, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Hugo J. Aparicio; hugoa{at}bu.edu

Abstract

Introduction Patients with stroke-like symptoms may be underutilising emergency medical services and avoiding hospitalisation during the COVID-19 pandemic. We investigated a decline in admissions for stroke and transient ischaemic attack (TIA) and emergency department (ED) stroke alert activations.

Methods We retrospectively compiled total weekly hospital admissions for stroke and TIA between 31 December 2018 and 21 April 2019 versus 30 December 2019 and 19 April 2020 at five US tertiary academic comprehensive stroke centres in cities with early COVID-19 outbreaks in Boston, New York City, Providence and Seattle. We collected available data on ED stroke alerts, stroke severity using the National Institutes of Health Stroke Scale (NIHSS) and time from symptom onset to hospital arrival.

Results Compared with 31 December 2018 to 21 April 2019, a decline in stroke/TIA admissions and ED stroke alerts occurred during 30 December 2019 to 19 April 2020 (p trend <0.001 for each). The declines coincided with state stay-at-home recommendations in late March. The greatest decline in hospital admissions was observed between 23 March and 19 April 2020, with a 31% decline compared with the corresponding weeks in 2019. Three of the five centres with 2019 and 2020 stroke alert data had a 46% decline in ED stroke alerts in late March and April 2020, compared with 2019. Median baseline NIHSS during these 4 weeks was 10 in 2020 and 7 in 2019. There was no difference in time from symptom onset to hospital arrival.

Conclusion At these five large academic US hospitals, admissions for stroke and TIA declined during the COVID-19 pandemic. There was a trend for fewer ED stroke alerts at three of the five centres with available 2019 and 2020 data. Acute stroke therapies are time-sensitive, so decreased healthcare access or utilisation may lead to more disabling or fatal strokes, or more severe non-neurological complications related to stroke. Our findings underscore the indirect effects of this pandemic. Public health officials, hospital systems and healthcare providers must continue to encourage patients with stroke to seek acute care during this crisis.

  • stroke
  • infection
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2020-000441

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    Footnotes

    • Contributors Study conception and design of work: Malveeka Sharma, MD, MPH; Vasileios Lioutas, MD; Tracy Madsen, MD, ScM; Tina M. Burton, MD; Amelia Boehme, PhD; Hugo J. Aparicio, MD, MPH. Data acquisition: Malveeka Sharma, MD, MPH; Vasileios Lioutas, MD; Tracy Madsen, MD, ScM; Judith Clark, Jillian O’Sullivan, Mitchell S. V. Elkind, MD, MS; Joshua Z. Willey, MD; Randolph S. Marshall, MD, Magdy H. Selim, MD, PhD; David Greer, MD, MA; David L. Tirschwell, MD, MSc; Tina M. Burton, MD; Amelia Boehme, PhD; Hugo J. Aparicio, MD, MPH. Data analysis and interpretation: Malveeka Sharma, MD, MPH; Vasileios Lioutas, MD; Tracy Madsen, MD, ScM; Tina M. Burton, MD; Amelia Boehme, PhD; Hugo J. Aparicio, MD, MPH. Statistical analysis: Amelia Boehme, PhD. Manuscript preparation: Malveeka Sharma, MD, MPH; Vasileios Lioutas, MD; Tracy Madsen, MD, ScM; Judith Clark, Jillian O’Sullivan, Tina M. Burton, MD; Amelia Boehme, PhD; Hugo J. Aparicio, MD, MPH. Manuscript editing: Malveeka Sharma, MD, MPH; Vasileios Lioutas, MD; Tracy Madsen, MD, ScM; Judith Clark, Jillian O’Sullivan, Mitchell S. V. Elkind, MD, MS; Joshua Z. Willey, MD; Randolph S. Marshall, MD; Magdy H. Selim, MD, PhD; David Greer, MD, MA; David L. Tirschwell, MD, MSc; Tina M. Burton, MD; Amelia Boehme, PhD; Hugo J. Aparicio, MD, MPH.

    • Funding This research is supported by the National Institutes of Health (NIH 1UL1TR001430). Dr. Aparicio is supported by the Boston University Aram V. Chobanian Assistant Professorship.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The institutional review boards at each centre approved the study and received approval from the ethical standards committee to conduct this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.