{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T04:23:30Z","timestamp":1775535810073,"version":"3.50.1"},"reference-count":9,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T00:00:00Z","timestamp":1609891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Many regions worldwide reported a decline of stroke admissions during the early phase of the coronavirus disease 2019 (COVID-19) pandemic. It remains unclear whether urban and rural regions experienced similar declines and whether deviations from historical admission numbers were more pronounced among specific age, stroke severity or treatment groups.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We used registry datasets from (a) nine acute stroke hospitals in Berlin, and (b) nine hospitals from a rural TeleNeurology network in Northeastern Germany for primary analysis of 3-week-rolling average of stroke\/TIA admissions before and during the COVID-19 pandemic. We compared course of stroke admission numbers with regional cumulative severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) infections. In secondary analyses, we used emergency department logs of the Berlin Charit\u00e9 University hospital to investigate changes in age, stroke severity, and thrombolysis\/thrombectomy frequencies during the early regional Sars-CoV-2 spread (March and April 2020) and compared them with preceding years.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Compared to past years, stroke admissions decreased by 20% in urban and 20-25% in rural hospitals. Deviations from historical averages were observable starting in early March and peaked when numbers of regional Sars-CoV-2 infections were still low. At the same time, average admission stroke severity and proportions of moderate\/severe strokes (NIHSS &amp;gt;5) were 20 and 20\u201340% higher, respectively. There were no relevant deviations observed in proportions of younger patients (&amp;lt;65 years), proportions of patients with thrombolysis, or number of thrombectomy procedures. Stroke admissions at Charit\u00e9 subsequently rebounded and reached near-normal levels after 4 weeks when the number of new Sars-CoV-2 infections started to decrease.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> During the early pandemic, deviations of stroke-related admissions from historical averages were observed in both urban and rural regions of Northeastern Germany and appear to have been mainly driven by avoidance of admissions of mildly affected stroke patients.<\/jats:p>","DOI":"10.3389\/fneur.2020.607193","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T04:49:33Z","timestamp":1609908573000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Stroke Admissions, Stroke Severity, and Treatment Rates in Urban and Rural Areas During the COVID-19 Pandemic"],"prefix":"10.3389","volume":"11","author":[{"given":"Hebun","family":"Erdur","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bob","family":"Siegerink","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Leithner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiana","family":"Franke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina","family":"Lorenz-Meyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Theen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anselm","family":"Angermaier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Kinze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim E.","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica L.","family":"Rohmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan F.","family":"Scheitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian H.","family":"Nolte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Endres","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heinrich J.","family":"Audebert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,1,6]]},"reference":[{"key":"B1","unstructured":""},{"key":"B2","unstructured":"Patients with heart attacks, strokes and even appendicitis vanish from hospitals\n            BernsteinL\n            Stead SellersF\n          The Washington Post"},{"key":"B3","unstructured":"American Heart Association News"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1996","DOI":"10.1161\/STROKEAHA.120.030225","article-title":"Impact of the COVID-19 epidemic on stroke care and potential solutions","volume":"51","author":"Zhao","year":"2020","journal-title":"Stroke"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1991","DOI":"10.1161\/STROKEAHA.120.030329","article-title":"Acute stroke care is at risk in the era of COVID-19: experience at a Comprehensive Stroke Center in Barcelona","volume":"51","author":"Rudilosso","year":"2020","journal-title":"Stroke."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2307","DOI":"10.1161\/STROKEAHA.120.030106","article-title":"Break in the stroke chain of survival due to COVID-19","volume":"51","author":"Montaner","year":"2020","journal-title":"Stroke."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2012","DOI":"10.2139\/ssrn.3571545","article-title":"Mechanical thrombectomy for acute ischemic stroke amid the COVID-19 outbreak: decreased activity, and increased care delays","volume":"51","author":"Kerleroux","year":"2020","journal-title":"Stroke."},{"key":"B8","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1056\/NEJMc2014816","article-title":"Collateral effect of Covid-19 on stroke evaluation in the United States","volume":"383","author":"Kansagra","year":"2020","journal-title":"N Engl J Med"},{"key":"B9","unstructured":"Charit\u00e9\u2013Universit\u00e4tsmedizinBerlin\n          Stroke and Heart Attack: Charit\u00e9 Appeal to the Citizens of Berlin to Urgently Seek Medical Help if They Experience Symptoms"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2020.607193\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T04:49:39Z","timestamp":1609908579000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2020.607193\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,6]]},"references-count":9,"alternative-id":["10.3389\/fneur.2020.607193"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2020.607193","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,6]]},"article-number":"607193"}}