Where have our patients gone? The impact of COVID-19 on stroke imaging and intervention at an Australian stroke center

INTRODUCTION: Australia has fortunately had a low prevalence coronavirus disease 2019 (COVID-19), and our healthcare system has not been overwhelmed. We aimed to determine whether, despite this, a decline in acute stroke presentations, imaging and intervention occurred during the pandemic at a busy stroke centre. METHODS: The number of 'code stroke' activations, multimodal CTs and endovascular clot retrievals (ECRs) performed during the pandemic period (3/1/2020-5/10/2020) at a large comprehensive stroke centre was compared against the pre-pandemic period (3/1/2019-1/31/2019) using Z-statistics. Year-on-year comparison of the number of patients with large vessel occlusions (LVOs) and ECRs performed per month was also made. RESULTS: The number of 'code stroke' activations and patients undergoing multimodal CT per month decreased significantly (P < 0.0025) following lockdown on 29th March. The number of ECRs also decreased (P = 0.165). The nadir in the weekly number of CTs coincided with lockdown and the peak of new COVID-19 cases. The number of patients with LVOs and ECRs increased by 15% and 14%, respectively, in March but decreased by 55% and 48%, respectively, in April. CONCLUSIONS: The significant decrease in volume of 'code stroke' activations and acute stroke imaging following lockdown was accompanied by a concomitant decrease in patients with LVOs and ECRs. The decrease in imaging was therefore not driven purely by patients with mild strokes and stroke mimics, but also included those with severe strokes. Since Australia had a low prevalence of COVID-19, this observed decrease cannot be attributed to hospital congestion and is instead likely driven by patient fear