Stroke evaluations drop by nearly 40% during COVID-19 pandemic

The number of people evaluated for signs of stroke at U.S. hospitals has dropped by nearly 40% during the COVID-19 pandemic, according to a study led by researchers from Washington University School of Medicine in St. Louis.

The researchers analyzed stroke evaluations at more than 800 hospitals across 49 states and the District of Columbia.

The findings, published May 8 in The New England Journal of Medicine, are a troubling indication that many people who experience strokes may not be seeking potentially lifesaving medical care.

Lead author Dr. Akash Kansagra, an assistant professor of radiology at Washington University's Mallinckrodt Institute of Radiology, who sees stroke patients at Barnes-Jewish Hospital, said that while the stroke team still has the full capacity to provide emergency stroke treatments, fewer stroke patients are coming into the hospital and many more are arriving after a considerable delay.

WHAT'S THE IMPACT?

Nearly 800,000 people in the U.S. experience a stroke every year. It is the fifth leading cause of death and the leading cause of long-term disability. With advances in stroke care such as better diagnostic tools, surgeries to remove blood clots or repair broken blood vessels, and clot-busting drugs, people have a better chance of recovering from a stroke today than ever before – as long as they receive treatment promptly.

Clot-busting drugs are generally safe only within four-and-a-half hours of symptom onset, and surgeries are only possible within 24 hours of symptom onset. The earlier the treatment is started, the more successful it is likely to be.

Worried by the low numbers of stroke patients being evaluated at Barnes-Jewish Hospital and hearing similar reports from colleagues at other institutions, Kansagra and the coauthors set out to determine how pervasive the problem was.

When patients arrive at a hospital and are showing signs of a stroke, they often get a brain scan so doctors can identify what kind of stroke has occurred and choose the most effective treatment. Many hospitals, including Barnes-Jewish, use software known as RAPID to analyze such brain scans. The colleagues assessed how often the software was used in February, before the pandemic, and during a two-week period from March 26 to April 8, when much of the country was under shelter-in-place orders.

In total, the software was used for 231,753 patients at 856 hospitals representing the District of Columbia and all 50 states except New Hampshire. During February, the software was used for an average of 1.18 patients per day per hospital. During the pandemic period, software use per hospital averaged 0.72 patients per day, a drop of 39%.

There's no reason to believe people suddenly stopped having strokes.Even severe stroke patients are seeking care at reduced rates. The drop was large even in places where COVID-19 cases were few and hospitals were not overwhelmed, so patients should not have found it unusually difficult to obtain treatment. Kansagra attributes this to the fear of contracting COVID-19, as well as the effects of social distancing. It's likely that many patients who suffer strokes aren't discovered quickly enough, and of course many are not in a position to call 911 themselves.

Common signs of a stroke include the sudden onset of numbness or weakness in the face, arm or leg, especially on one side of the body; speech difficulty; confusion; difficulty seeing or walking; and severe headache.

Even during a pandemic, it is critically important for people who may be experiencing a stroke to receive care immediately, Kansagra said. The risk of delaying care for a stroke is much greater than the risk of contracting COVID-19.

THE LARGER TREND

As of early Monday afternoon, the U.S. continued to lead the world in confirmed coronavirus cases with 1,332,609, according to the Johns Hopkins data. The U.S. also leads the world in deaths related to the disease, at 79,607.

Globally, there have been 4,137,591 confirmed cases and 283,526 deaths.
 

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com