• Prakash R Paliwal, Benjamin Y Q Tan, Aloysius S T Leow, Sunny Sibi, Daniel W P Chor, Amanda X Y Chin, Ying-Wei Yau, Gail B Cross, WongLily Y HLYHDivision of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore., Magdalene L J Chia, Zhixuan Quak, Christopher Y K Chua, David K K Tang, Ei The Zune, Jennifer Hung, Yihui Goh, Mingxue Jing, Anil Gopinathan, Cunli Yang, Aftab Ahmad, Deborah X L Khoo, Chang-Chuan M Lee, SeetRaymond C SRCSDivision of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Vijay K Sharma, Hock-Luen Teoh, YeoLeonard L LLLLDivision of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. leonardyeoll@gmail.com.Yong Loo Lin School of Medicine, National University , and ChanBernard P LBPLDivision of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore..
• Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
• J. Thromb. Thrombolysis. 2020 Oct 1; 50 (3): 596-603.

AbstractThe 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.

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