Code Stroke Patient Referral by Emergency Medical Services During the Public COVID-19 Pandemic Lockdown

Benno Ikenberg, Bernhard Hemmer, Michael Dommasch, Karl Georg Kanz, Silke Wunderlich, Benjamin Knier

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: The COVID-19 pandemic caused public lockdowns around the world. We analyzed if the public lockdown altered the referral pattern of Code Stroke patients by Emergency Medical Services (EMS) to our Comprehensive Stroke Center. Methods: Retrospective single-center study at a Bavarian Comprehensive Stroke Center. Patients who were directly referred to our stroke unit by EMS between the 1st of January 2020 and the 19th of April 2020 were identified and number of referrals, clinical characteristics and treatment strategies were analyzed during the public lockdown and before. The public lockdown started on 21st of March and ended on 19th April 2020. Results: In total 241 patients were referred to our center during the study period, i.e. 171 before and 70 during the lockdown. The absolute daily number of Code Stroke referrals and the portion of patients with stroke mimics remained stable. The portion of female stroke patients decreased (55% to 33%; p = 0.03), and stroke severity as measured by the National Institutes of Health Stroke Scale (median 3 (IQR 0-7) versus 6 (IQR 1-15.5) points; p = 0.04) increased during the lockdown. There was no difference of daily numbers of patients receiving thrombolysis and thrombectomy. Conclusions: Referral of Code Stroke patients by EMS could be maintained sufficiently despite the COVID-19 pandemic lockdown. However, patients’ health care utilization of the EMS may have changed within the public lockdown. EMS remains a useful tool for Code Stroke patient referral during lockdowns, but public education about stroke is required prior to further lockdowns.

Original languageEnglish
Article number105175
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number11
StatePublished - Nov 2020
Externally publishedYes


  • COVID-19
  • Hospital referral
  • Lockdown
  • Stroke
  • Stroke mimic


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