Impact of the COVID-19 Pandemic on Acute Stroke Care, Time Metrics, Outcomes, and Racial Disparities in a Southeast Michigan Health System

Hassan Aboul Nour, Muhammad Affan, Ghada Mohamed, Ali Mohamud, Lonni Schultz, Katie Latack, Megan Brady, Dawn Scozzari, Yazeed Haddad, Angelos Katramados, Alex Bou Chebl, Ahmad Riad Ramadan

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


BACKGROUND: COVID-19 has impacted acute stroke care with several reports showing worldwide drops in stroke caseload during the pandemic. We studied the impact of COVID-19 on acute stroke care in our health system serving Southeast Michigan as we rolled out a policy to limit admissions and transfers.

METHODS: in this retrospective study conducted at two stroke centers, we included consecutive patients presenting to the ED for whom a stroke alert was activated during the period extending from 3/20/20 to 5/20/20 and a similar period in 2019. We compared demographics, time metrics, and discharge outcomes between the two groups.

RESULTS: of 385 patients presented to the ED during the two time periods, 58% were African American. There was a significant decrease in the number of stroke patients presenting to the ED and admitted to the hospital between the two periods (p <0.001). In 2020, patients had higher presenting NIHSS (median: 2 vs 5, p = 0.012), discharge NIHSS (median: 2 vs 3, p = 0.004), and longer times from LKW to ED arrival (4.8 vs 9.4 h, p = 0.031) and stroke team activation (median: 10 vs 15 min, p = 0.006). In 2020, stroke mimics rates were lower among African Americans. There were fewer hospitalizations (p <0.001), and transfers from outside facilities (p = 0.015).

CONCLUSION: a trend toward faster stroke care in the ED was observed during the pandemic along with dramatically reduced numbers of ED visits, hospitalizations and stroke mimics. Delayed ED presentations and higher stroke severity characterized the African American population, highlighting deepening of racial disparities during the pandemic.

Original languageEnglish (US)
Article number105746
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number6
StatePublished - Jun 2021

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Inc.


  • Ethnicity
  • Metrics
  • Outcomes
  • Race
  • Racial disparities
  • Stroke volume
  • Outcome and Process Assessment, Health Care/trends
  • Humans
  • Middle Aged
  • Male
  • Race Factors
  • COVID-19
  • Young Adult
  • Time Factors
  • Aged, 80 and over
  • Adult
  • Female
  • Retrospective Studies
  • Stroke/diagnosis
  • Risk Assessment
  • Quality Indicators, Health Care/trends
  • Risk Factors
  • Time-to-Treatment/trends
  • Treatment Outcome
  • Patient Acceptance of Health Care/ethnology
  • Michigan/epidemiology
  • Healthcare Disparities/ethnology
  • Aged
  • Emergency Service, Hospital/trends
  • Hospitalization/trends

PubMed: MeSH publication types

  • Journal Article
  • Comparative Study


Dive into the research topics of 'Impact of the COVID-19 Pandemic on Acute Stroke Care, Time Metrics, Outcomes, and Racial Disparities in a Southeast Michigan Health System'. Together they form a unique fingerprint.

Cite this