A meta-analysis of the global impact of the COVID-19 pandemic on stroke care & the Houston Experience

Sujan T. Reddy, Nikunj Satani, Jennifer E.S. Beauchamp, Sudhakar Selvaraj, Suja S. Rajan, Mohammad H. Rahbar, Amirali Tahanan, Sori Kim, Travis Holder, Xiaoqian Jiang, Luyao Chen, Haris Kamal, Hari Kishan R. Indupuru, Tzu Ching Wu, Sean I. Savitz

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: To review the global impact of the COVID-19 pandemic on stroke care-metrics and report data from a health system in Houston. Methods: We performed a meta-analysis of the published literature reporting stroke admissions, intracerebral hemorrhage (ICH) cases, number of thrombolysis (tPA) and thrombectomy (MT) cases, and time metrics (door to needle, DTN; and door to groin time, DTG) during the pandemic compared to prepandemic period. Within our hospital system, between January–June 2019 and January–June 2020, we compared the proportion of stroke admissions and door to tPA and MT times. Results: A total of 32,640 stroke admissions from 29 studies were assessed. Compared to prepandemic period, the mean ratio of stroke admissions during the pandemic was 70.78% [95% CI, 65.02%, 76.54%], ICH cases was 83.10% [95% CI, 71.01%, 95.17%], tPA cases was 81.74% [95% CI, 72.33%, 91.16%], and MT cases was 88.63% [95% CI, 74.12%, 103.13%], whereas DTN time was 104.48% [95% CI, 95.52%, 113.44%] and DTG was 104.30% [95% CI, 81.99%, 126.61%]. In Houston, a total of 4808 cases were assessed. There was an initial drop of ~30% in cases at the pandemic onset. Compared to 2019, there was a significant reduction in mild strokes (NIHSS 1-5) [N (%), 891 (43) vs 635 (40), P = 0.02]. There were similar mean (SD) (mins) DTN [44 (17) vs 42 (17), P = 0.14] but significantly prolonged DTG times [94 (15) vs 85 (20), P = 0.005] in 2020. Interpretation: The COVID-19 pandemic led to a global reduction in stroke admissions and treatment interventions and prolonged treatment time metrics.

Original languageEnglish (US)
Pages (from-to)929-937
Number of pages9
JournalAnnals of Clinical and Translational Neurology
Issue number4
Early online dateFeb 22 2021
StatePublished - Apr 2021


  • Brain Ischemia/epidemiology
  • COVID-19/epidemiology
  • Fibrinolytic Agents/administration & dosage
  • Humans
  • Pandemics
  • Patient Admission/trends
  • Stroke/epidemiology
  • Texas/epidemiology
  • Thrombectomy/trends
  • Thrombolytic Therapy/trends

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)


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