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Open Access

Decline in stroke alerts and hospitalisations during the COVID-19 pandemic

Malveeka Sharma, Vasileios-Arsenios Lioutas, Tracy Madsen, Judith Clark, Jillian O'Sullivan, Mitchell S. V. Elkind, Joshua Z. Willey, Randolph S. Marshall, Magdy H. Selim, David Greer, David L. Tirschwell, Tina Burton, Amelia Boehme, Hugo J. Aparicio
DOI: 10.1136/svn-2020-000441 Published 29 December 2020
Malveeka Sharma
1 Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
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  • ORCID record for Malveeka Sharma
Vasileios-Arsenios Lioutas
2 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Tracy Madsen
3 Deparment of Emergency Medicine, Brown University, Providence, Rhode Island, USA
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Judith Clark
4 Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
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Jillian O'Sullivan
2 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Mitchell S. V. Elkind
5 Department of Neurology, Vagelos College of Physicians and Surgeon, Columbia University, New York, New York, USA
6 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Joshua Z. Willey
5 Department of Neurology, Vagelos College of Physicians and Surgeon, Columbia University, New York, New York, USA
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Randolph S. Marshall
5 Department of Neurology, Vagelos College of Physicians and Surgeon, Columbia University, New York, New York, USA
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Magdy H. Selim
2 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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David Greer
4 Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
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David L. Tirschwell
1 Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
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Tina Burton
7 Department of Neurology, Brown University, Providence, Rhode Island, USA
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Amelia Boehme
5 Department of Neurology, Vagelos College of Physicians and Surgeon, Columbia University, New York, New York, USA
6 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Hugo J. Aparicio
4 Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
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    Figure 1

    Weekly admissions for stroke and transient ischaemic attack (TIA) in the first 16 weeks of 2019 and 2020. Data from five medical centres in Boston, New York City, Providence and Seattle.

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    Figure 2

    Weekly emergency department (ED) stroke alert activations in the first 16 weeks of 2019 and 2020. Data from three medical centres in New York City, Providence and Seattle.

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  • Table 1

    Stroke and TIA admissions, emergency department stroke alerts, stroke severity and delay to hospital presentation during the COVID-19 pandemic at US medical centres

    2019
    25 March to 21 April
    2020
    23 March to 19 April*
    Stroke/TIA admissions, n410281
     Stroke only†391274
     TIA only197
    ED stroke alerts, n‡561301
    Baseline NIHSS, median score (range)7 (7–10)10 (8–11)
    Stroke symptom onset to hospital arrival, median hours (range)6.9 (5.4–8.0)7.6 (4.9–12.5)
    • *Univariate analyses comparing 2020 with 2019 measures were statistically significant (p<0.01), except for median time from stroke symptom onset to hospital arrival (p=0.14).

    • †Includes admissions for ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage.

    • ‡Including three medical centres in New York City, Providence and Seattle with available data.

    • ED, emergency department; NIHSS, National Institutes of Health Stroke Scale; TIA, transient ischaemic attack.

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Stroke and Vascular Neurology: 5 (4)
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Decline in stroke alerts and hospitalisations during the COVID-19 pandemic
Malveeka Sharma, Vasileios-Arsenios Lioutas, Tracy Madsen, Judith Clark, Jillian O'Sullivan, Mitchell S. V. Elkind, Joshua Z. Willey, Randolph S. Marshall, Magdy H. Selim, David Greer, David L. Tirschwell, Tina Burton, Amelia Boehme, Hugo J. Aparicio
Stroke and Vascular Neurology Dec 2020, 5 (4) 403-405; DOI: 10.1136/svn-2020-000441

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Decline in stroke alerts and hospitalisations during the COVID-19 pandemic
Malveeka Sharma, Vasileios-Arsenios Lioutas, Tracy Madsen, Judith Clark, Jillian O'Sullivan, Mitchell S. V. Elkind, Joshua Z. Willey, Randolph S. Marshall, Magdy H. Selim, David Greer, David L. Tirschwell, Tina Burton, Amelia Boehme, Hugo J. Aparicio
Stroke and Vascular Neurology Dec 2020, 5 (4) 403-405; DOI: 10.1136/svn-2020-000441
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Decline in stroke alerts and hospitalisations during the COVID-19 pandemic
Malveeka Sharma, Vasileios-Arsenios Lioutas, Tracy Madsen, Judith Clark, Jillian O'Sullivan, Mitchell S. V. Elkind, Joshua Z. Willey, Randolph S. Marshall, Magdy H. Selim, David Greer, David L. Tirschwell, Tina Burton, Amelia Boehme, Hugo J. Aparicio
Stroke and Vascular Neurology Dec 2020, 5 (4) 403-405; DOI: 10.1136/svn-2020-000441
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