The effect of COVID-19 on stroke hospitalizations in New York City
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Published on: May 22, 2019
Charles Esenwa1, Michael K Parides2, Daniel L Labovitz1
1Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Ave, 4th floor, Bronx, NY 10467.
Insights
The Coronavirus disease 2019 (COVID-19) pandemic significantly reduced acute stroke hospitalizations by 44% in New York City. Stroke admissions began declining two weeks before the pandemic surge, indicating potential underdiagnosis and undertreatment.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The impact of the Coronavirus disease 2019 (COVID-19) pandemic on stroke care remains largely unknown.
- Acute stroke hospitalizations during the pandemic have not been previously described.
Purpose of the Study:
- To analyze the effect of the COVID-19 pandemic on stroke admission rates.
- To describe the impact of the epidemic on hospitalizations for acute ischemic stroke, intraparenchymal hemorrhage, and subarachnoid hemorrhage.
Main Methods:
- Retrospective analysis of stroke admissions in three New York City hospitals.
- Data collected from January 1, 2020, to April 17, 2020.
- Inclusion of all acute ischemic stroke, intraparenchymal hemorrhage, and subarachnoid hemorrhage cases.
Main Results:
- A total of 518 out-of-hospital stroke cases were confirmed.
- Stroke admissions were stable before February 25, 2020 (average 41 daily admissions).
- During the pandemic period, weekly stroke admissions decreased by 44% (average 23 weekly admissions), a statistically significant reduction (p=0.005).
- The decline in admissions was consistent across patient demographics (age, sex, race/ethnicity).
Conclusions:
- Stroke admission rates began declining two weeks prior to the local COVID-19 surge.
- The COVID-19 pandemic led to a significant decrease in acute stroke hospitalizations.
- Potential severe and lasting consequences are anticipated due to missed diagnoses and delayed treatment for acute stroke patients.
Background:
Little is known about the effect of the Coronavirus disease 2019 pandemic on stroke care and the impact of the epidemic on acute stroke hospitalizations has not been described.
Methods:
We analyze the stroke admission rate in three hospitals in New York City from January 1, 2020 through April 17, 2020, identifying all cases of acute ischemic stroke, intraparenchymal hemorrhage and subarachnoid hemorrhage.
Results:
We confirmed 518 cases of out-of-hospital stroke. During the baseline period up to February 25, 2020, the daily stroke admission rate was stable, with the slope of the regression describing the number of admissions over time equal to -0.33 (se = 1.21), not significantly different from 0 (p = 0.79), with daily admissions averaging 41. During the pandemic period, the slope was -4.4 (se = 1.00); i.e., the number of stroke admissions decreased an average of 4.4 per week, (p = 0.005), with weekly admissions averaging 23, a reduction of 44% versus baseline. This general result was not different by patient age, sex, or race/ethnicity.
Conclusions:
The weekly stroke admission rate started declining two weeks prior to the local surge of coronavirus admissions. The consequences of lack of diagnosis and treatment of a large proportion of acute stroke patients are likely severe and lasting.
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