Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?

Abstract

Despite the evidence suggesting a high rate of cerebrovascular complications in patients with SARS-CoV-2, reports have indicated decreasing rates of new ischemic stroke diagnoses during the COVID-19 pandemic. The observed decrease in emergency department (ED) visits is unsurprising during this major crisis, as patients are likely to prioritize avoiding exposure to SARS-CoV-2 over addressing what they may perceive as mild symptoms of headache, lethargy, difficulty speaking, and numbness. In the central and south Texas regions where we practice, we suspect that patient admission, treatment, and discharge volumes for acute stroke treatment have decreased significantly since COVID-19–related shelter-at-home orders were issued. Symptoms of stroke are frequently noticed by a family member, friend, or community member before they are recognized by the patients themselves, and these symptoms may be going unnoticed due to limited face-to-face encounters. This possibility emphasizes the importance of patient education regarding stroke warning signs and symptoms during the current period of isolation and social-distancing. The south Texas population, already saddled with above-average rates of cardiovascular and cerebrovascular disease, has a higher stroke mortality rate compared to Texas and U.S. averages; however, the number of patients presenting to EDs with acute ischemic stroke diagnoses is lower than average. In our viewpoint, we aim to present the relative literature to date and outline our ongoing analyses of the highly affected and diverse stroke populations in San Antonio and Austin, Texas, to answer a simple question: where did all our stroke patients go?

Emergency department visits for emergent conditions among older adults during the COVID‐19 pandemic

“…The overall decline in ED visits across all ages observed in our study is consistent with findings from prior studies describing reduced acute care utilization for non‐COVID conditions 4–7 . However, the finding of greater and more persistent ED visit decline among the older and oldest adults (those greater than 75 and 85 years of age respectively) compared with younger adults across a diverse set of conditions has not been demonstrated previously.…”

“…The overall decline in ED visits across all ages observed in our study is consistent with findings from prior studies describing reduced acute care utilization for non-COVID conditions. [4][5][6][7] However, the finding of greater and more persistent ED visit decline among the older and oldest adults (those greater than 75 and 85 years of age respectively) compared with younger adults across a diverse set of conditions has not been demonstrated previously. This finding of mounting declines in visit counts for emergent conditions, in successively increasing age strata, is concerning not only because of the increasing prevalence of these conditions with advanced age but also because of the accompanying greater risk for adverse outcomes in older adults.…”

Impact of the COVID-19 pandemic on radiology department emergency ultrasound utilization

“…The NYC Department of Health and Mental Hygiene reported 24,172 deaths in excess of the seasonal expected baseline between March 11 and May 2 of 2020, with 22% of those deaths not identified as being COVID-19 associated [16]. Reports of decreased rates of diagnoses of specific non-COVID illnesses with increased disease severity, such as acute appendicitis and strokes, have been described [17][18][19]. While the emergency department volume of our hospitals decreased in the pandemic period, the percentage of ED visits resulting in hospital admission rose, likely due to the higher acuity of COVID patients.…”

Risk Perception, Preventive Behavior, and Medical Care Avoidance among American Older Adults During the COVID-19 Pandemic

“…In June 2020, a nationwide survey comprised representative US adults aged 18 years and older indicated 40.9% avoided or delayed medical care during the pandemic because of concern about COVID-19 exposure in the hospital (Czeisler et al, 2020). Medical professionals have raised concerns about the decreased diagnosis of some diseases, such as stroke (Dula et al, 2020) and their potential harm to older adults' health (Sharma et al, 2020).…”