This study aims to analyze stroke code timings to determine delays during the Coronavirus Disease 2019 (COVID-19) pandemic compared to the pre-pandemic period. 

All stroke codes and stroke discharges from a comprehensive stroke center in New Jersey between February to April 2020 were included in this study. They were divided into two groups- the pandemic period (3/15/2020 to 4/30/2020) and the pre-pandemic period (2/1/2020 to 3/14/2020). The stroke code timings, including the discovery of symptoms to emergency room (ER) arrival, door to stroke alert times, door to CT times, and door to needle times were compared.

There was a total of 183 stroke codes from the ER during this study period, with no significant difference in the number of stroke codes between the two groups. The ER arrival to tPA administration time was 65.4 (±16.5) minutes during the pandemic compared to 44.8 (±17.2) minutes in the pre-pandemic period (P-value = 0.01). Discovery of symptoms to ER arrival (P=0.01), ER arrival to stroke alert time (P=0.0021), and CT scan time (P=0.015) were delayed significantly in patients who had respiratory symptoms.

There were significant delays in stroke code timings during the pandemic, which were attributed to both medical and in-hospital reasons. Our study highlights the impact the pandemic has had on the management of  stroke. Increasing public awareness that stroke-like symptoms should not be ignored during the pandemic and maintaining a dedicated stroke team in hospitals are necessary.