Impact of the COVID-19 pandemic on hyperacute stroke treatment: experience from a comprehensive stroke centre in Singapore

J Thromb Thrombolysis. 2020 Oct;50(3):596-603. doi: 10.1007/s11239-020-02225-1.


The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p = 0.004, 95% CI 6.513 to - 2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable (p = 0.519, 95% CI - 1.605 to 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 h (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.

Keywords: Acute ischaemic stroke; COVID-19; Recanalization therapy; Stroke activation.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • COVID-19
  • Comprehensive Health Care / organization & administration*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / therapy*
  • Delivery of Health Care, Integrated / organization & administration*
  • Emergency Service, Hospital / organization & administration
  • Female
  • Health Services Needs and Demand / organization & administration*
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Patient Care Team / organization & administration
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / therapy*
  • Recovery of Function
  • Referral and Consultation / organization & administration
  • Singapore / epidemiology
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / therapy*
  • Time Factors
  • Time-to-Treatment / organization & administration
  • Treatment Outcome
  • Workflow