Decline in Stroke Alerts and Hospitalizations During the COVID-19 Pandemic

Introduction: Patients with stroke-like symptoms may be underutilizing emergency medical services and avoiding hospitalization during the coronavirus infectious disease 2019 (COVID-19) pandemic We investigated a decline in emergency department (ED) stroke alert activations and admissions for stroke and transient ischemic attack (TIA) Methods: We retrospectively compiled total weekly ED stroke alerts and hospital admissions between 12/31/2018 and 4/7/2019 versus 12/30/2019 and 4/5/2020 at five U S tertiary academic comprehensive stroke centers in cities with early COVID-19 outbreaks in Boston, New York City, Providence, and Seattle We collected data on admission stroke severity using the National Institutes of Health Stroke Scale (NIHSS) Time series regression models (autoregressive integrated moving average: ARIMA) and time series forecasting systems were used to assess the interrelationship of weekly stroke alerts and admissions, separately The standard variation of weekly stroke alerts and admissions were compared to the same measures in 2019 Results: Compared to 12/31/2018-4/7/2019, a decline in stroke alerts and admissions occurred during 12/30/2019-4/5/2020 (p<0 001 for each) The declines coincided with state stay-at-home recommendations in late March The greatest decline in cases was observed between March 23 and April 5, 2020, where 156 admissions represented a 39% decline compared to the corresponding weeks in 2019 At three centers with 2019/2020 stroke alert data there was a 25% decline in alerts compared to 2019 The median NIHSS for all centers was 10 and 11 for the weeks of March 23 and 30, 2020, versus a median NIHSS of 7 and 11 for the weeks of March 25 and April 1, 2019 Conclusion: At these five large academic U S hospitals, ED stroke alerts and admissions for stroke and TIA declined during the COVID-19 pandemic Acute stroke therapies are time-sensitive, so decreased healthcare access or utilization may lead to more disabling or fatal strokes, or more severe non-neurologic 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 stroke patients to seek acute care during this crisis