Physicians from the Holy Cross Hospital in Ft. Lauderdale, Florida have reported a decline in the average number of monthly stroke admissions to their emergency department (ED) during the coronavirus disease 2019 (COVID-19) pandemic. Comparatively, they noted that an increased number of young patients have presented with the need for acute stroke intervention. Observations from this hospital were reported in the Journal of Stroke and Cerebrovascular Diseases.

Located in south Florida, Holy Cross Hospital is a Thrombectomy Stroke Center whose county ranked second in COVID-19 cases and deaths. From the first 2 weeks of March 2020 to the final 2 weeks of April 2020, there was a substantial decrease in ED visits at this center from 2349 to 1178, respectively.

During this time period, the number of stroke alerts decreased from 34 to 14 as well. A total of 46 patients were admitted to the hospital with an acute stroke in both March and April of 2020, compared with 68 in 2019. Only 7 stroke neurointervention cases were observed during this period compared with 14 in the year prior.

Although there were marked declines in ED visits as well as in the number stroke alerts and stroke neurointervention cases, there were 12 tissue plasminogen activator (tPA) eligible patients in the month of March 2020. In contrast, the typical number of tPA-eligible patients at this center was 6 per month.


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Additionally, the physicians noted that significantly more patients aged ≤60 years underwent any acute stroke intervention, including tPA and/or neurointervention, during this time. While only 2 of 13 patients underwent any intervention in 2019, 5 of 12 patients ≤60 years of age underwent such procedures in March 2020. Thrombectomy cases included 2 patients aged 31 and 35 years, both of whom were also African American.

According to the physicians, it was difficult to determine whether the increase in the number of tPA-eligible patients was related to COVID-19 infection, as testing was not widespread during the studied time periods. Additionally, pandemic-related factors could have contributed to medication noncompliance and changes in lifestyle, each of which may have exacerbated risk factors for neurologic conditions.

It will be “imperative,” concluded the physicians, “that we determine what mechanisms underlie these changes so that we can implement both preventative strategies and continue the most effective acute stroke treatments.”

Reference

Strasser S, Miskolczi L, Cunha J, Justynski L. COVID-19 impact on stroke presentations [published online June 25, 2020]. J Stroke Cerebrovasc Dis. doi:10.1016/j.jstrokecerebrovasdis.2020.105077