We aimed to evaluate utilization of inpatient hospital and critical care services among critically ill neurologic patients during the COVID-19 pandemic. We hypothesized, based on prior observations among ischemic stroke patients, that there would be significant decline in critically ill neurologic patients presenting to hospitals during the pandemic which may impact outcomes.

We found a 28.1% reduction in intensive care unit (ICU) admissions with critical neurologic illnesses in 2020 when compared to 2019 (8568 vs. 11,917 patients, p < 0.0001) and a 34.4% reduction compared to 2018 (8568 vs. 13,064 patients, p < 0.0001). However, there was no statistically significant difference in mortality (2020: 12.2 vs. 2019: 12.4%; p = 0.7; vs. 2018: 12.6%; p = 0.62) or intubation rates across the years among patients using critical care services. There was 1% increase in mortality among non-ICU patients with similar diagnoses in 2020 compared to previous years (2020: 3.9% vs. 2019: 2.9% vs. 2018: 3.1%; p < 0.0001, p = 0.0001), but no difference in intubation rates.