COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals

Abstract

We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.

Stroke Care Within the COVID-19 Pandemic—Increasing Awareness of Transient and Mild Stroke Symptoms Needed

“…We observed a decrease by nearly one quarter in the number of patients admitted to our primary stroke center with stroke or TIA from a mean-rate of 95.9 (±6.3) per month between January 2019 and February 2020 to 74 (±12.7) in March/April 2020. Our observation is in line with numerous reports of decreased stroke rates during the pandemic from North America ( 4 , 9 , 10 ), Canada ( 5 ), and Brazil ( 6 ). In addition, a decrease in the usage of the RAPID-software, a tool used to assess infarct volume in case of acute stroke symptoms, was observed by mid-March 2020 ( 11 ) and telestroke services were less frequently used ( 9 ).…”

“…Moreover, the organizational structure of hospitals changed in order to be prepared for an increased admission of COVID-19 patients by reducing non-emergency ambulatory patients and elective hospital admissions. These circumstances led to the question of what happens with other severe disease such as stroke, especially considering reports from Italian colleagues depicting almost a disappearance of patients with ischemic strokes within their hospitals ( 3 ) and similar reports from North America ( 4 , 5 ) and Brazil ( 6 ). We aim to elucidate whether the COVID-19 pandemic affected either the admission of patients to our primary care stroke center or the rates of stroke recanalization therapies.…”

Effect of COVID-19 on computed tomography usage and critical test results in the emergency department: an observational study

“…9 Many physicians and hospitals have reported a reduction in ED visits and hospital admissions for acute illness since the onset of the COVID-19 pandemic. [10][11][12][13][14][15] There are, however, few to no data comparing the effects of COVID-19 on the diagnosis of illnesses of different urgency on imaging. Furthermore, the effects of the COVID-19 pandemic on the diagnosis of many acute illnesses have not been independently assessed.…”

Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large US Academic Medical Center

“…This lack of care seeking has been associated with an increase in mortality rates from non-COVID conditions. 1 , 2 , 3 , 4 Some of this anxiety may have been provoked by reports of widespread outbreaks of SARS-CoV-2 infection within skilled nursing facilities and other congregate settings. 5 , 6 There are few data, however, on the adequacy of infection control practices and the risk of acquiring COVID-19 in US acute care hospitals.…”