COVID-19 Cuts Stroke Cases Nearly 40% Nationwide

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What your doctor is reading on Medscape.com:

MAY 12, 2020 — Almost 4 in 10 people experiencing an acute stroke during the COVID-19 pandemic in the United States appear to be avoiding emergency hospital care, new evidence suggests.

The number of people seeking stroke treatment dropped 39% in 2 weeks from late March through early April — at the height of stay-at-home orders nationwide — compared to pre-pandemic levels.

“I was very surprised by the magnitude of the decline. One of the reasons that hospitals reduced elective care was to maintain availability of hospital resources to treat COVID-19 and other critical conditions like stroke,” lead author Akash Kansagra, MD, told Medscape Medical News.

The decrease, he added, is “unexpected and alarming.”

The study was published online May 8 as a Letter to the Editor in the New England Journal of Medicine.

The findings add data to a series of anecdotal reports about a noticeable drop in stroke patients in New Orleans, Chicago, Seattle, and elsewhere, as previously reported by Medscape Medical News.

“Unlike earlier anecdotal reports, we have an enormous dataset representing almost a quarter million patients across virtually all of the United States,” said Kansagra, director of endovascular surgical neuroradiology and codirector of the Stroke and Cerebrovascular Center at the Washington University School of Medicine and Barnes-Jewish Hospital in St Louis, Missouri.

The investigators analyzed data for 231,753 patients from 856 hospitals nationwide from July 1, 2019 to April 27, 2020. All patients underwent brain imaging interpreted with the help of RAPID software (iSchemaView, Menlo Park, California). The manufacturer collects results on a continuous basis.

Kansagra and colleagues compared the number of people in this neuroimaging database during 14 days from March 26 to April 8, 2020 versus cases in February 2020.

They found the rate dropped from 1.18 patients per hospital per day seeking acute care in February to 0.72 per hospital per day, a 39% decrease.

“What was also very unexpected was that this decline affected even patients with severe strokes or living in states with low COVID-19 burden,” said Kansagra, who is also assistant professor of radiology, neurological surgery, and neurology at the Washington University School of Medicine.

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