Impact of COVID-19 on hospital admission of acute stroke patients in Bangladesh

Abstract

Background With the proposed pathophysiologic mechanism of neurologic injury by SARS CoV-2, the frequency of stroke and henceforth the related hospital admissions were expected to rise. This paper investigated this presumption by comparing the frequency of admissions of stroke cases in Bangladesh before and during the pandemic. Methods This is a retrospective analysis of stroke admissions in a 100-bed stroke unit at the National Institute of Neurosciences and Hospital (NINS&H) which is considerably a large stroke unit. All the admitted cases from 1 January to 30 June 2020 were considered. Poisson regression models were used to determine whether statistically significant changes in admission rates can be found before and after 25 March since when there is a surge in COVID-19 infections. Results A total of 1394 stroke patients took admission in the stroke unit during the study period. Half of the patients were older than 60 years, whereas only 2.6% were 30 years old or younger. The male to female ratio is 1.06:1. From January to March 2020, the mean rate of admission was 302.3 cases per month, which dropped to 162.3 cases per month from April to June, with an overall reduction of 46.3% in acute stroke admission per month. In those two periods, reductions in average admission per month for ischemic stroke (IST), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and venous stroke (VS) were 45.5%, 37.2%, 71.4% and 39.0%, respectively. Based on weekly data, results of Poisson regressions confirm that the average number of admissions per week dropped significantly during the last three months of the sample period. Further, in the first three months, a total of 22 cases of hyperacute stroke management were done, whereas, in the last three months, there was an 86.4% reduction in the number of hyperacute stroke patients getting reperfusion treatment. Only 38 patients (2.7%) were later found to be RT-PCR SARS Cov-2 positive based on nasal swab testing. Conclusion This study revealed a more than fifty percent reduction in acute stroke admission during the COVID-19 pandemic. Whether the reduction is related to the fear of getting infected by COVID-19 from hospitalization or the overall restriction on public movement or stay-home measures remains unknown.

Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis

“…Most studies compared the pandemic period (ranging from January to June 2020) to a similar period in the preceding year (range January to June 2019) [28][29][30][31]33,35,39,[41][42][43]45,46,[48][49][50]52,[54][55][56][57][58]60 or the months preceding the pandemic (range September 2019 to December 2019). 8,32,34,[36][37][38]40,44,47,51,53,59,[61][62][63]…”

Consumer side economic perception of telemedicine during COVID-19 era: A survey on Bangladesh's perspective

“…From the perspective of Bangladesh, according to research led by A T M Hasibul et al, there was a 50% reduction in acute stroke admission during the COVID-19 pandemic. However, it wasn't mentioned whether it was due to fear of COVID-19 infection or other issues [ 32 ]. Nonetheless, it is noteworthy that hospitals in different parts of the world had lost many of their visitors due to known and unknown reasons during the COVID-19 era.…”

Impact of COVID-19 pandemic on haemorrhagic stroke admissions: a systematic review and meta-analysis

“…Sensitivity analysis shows that the study of Hasan et al 30 has a significant impact on the outcomes of SAH. As for the outcomes of HS and ICH, there is no individual study that has a significant impact on the outcomes.…”

“…A total sample of 14 445 subjects from 17 studies was included in the systematic review. The studies were conducted in many countries worldwide including Italy, 15 17 20 United Arab Emirates, 18 the USA, 16 Germany, 19 24 25 Ghana, 22 Turkey, 26 Switzerland, 27 Austria, 28 Iran, 29 Bangladesh, 30 Spain 31 32 and Egypt. 23 These studies included retrospective-observational studies and prospective and retrospective studies.…”