Patient Characteristics and Outcomes Associated with Decline in Stroke Volumes during the Early COVID-19 Pandemic

Abstract Background and Purpose Delayed evaluation of stroke may contribute to COVID-19 pandemic-related morbidity and mortality. This study evaluated patient characteristics, process measures and outcomes associated with the decline in stroke presentation during the early pandemic. Methods Volumes of stroke presentations, intravenous thrombolytic administrations, and mechanical thrombectomies from 52 hospitals from January 1-June 30, 2020 were analyzed with piecewise linear regression and linear spline models. Univariate analysis compared pandemic (case) and control groups defined in relation to the nadir of daily strokes during the study period. Significantly different patient characteristics were further evaluated with logistic regression, and significantly different process measures and outcomes were re-analyzed after propensity score matching. Results Analysis of 7,389 patients found daily stroke volumes decreased 0.91/day from March 12-26 (P Conclusion Stroke presentations and acute interventions decreased during the early COVID-19 pandemic, at least in part due to patients with milder symptoms and lower functional status not seeking medical care. Public health messaging and initiatives should target these populations.