Slump in Hospital Admissions for Stroke, a Fact of an Uncertain Nature That Requires Explanation

Abstract

(1) Background: The impact of the health crisis caused by coronavirus disease 2019 (COVID-19) has provoked collateral effects in the attention to pathologies with time-dependent treatments such as strokes. We compare the healthcare activity of two stroke units in the same periods of 2019 and 2020, with an emphasis on what happened during the state of alarm (SA). (2) Materials and methods. Hospitals in the region implemented contingency plans to contain the pandemic; in this planning, the stroke units were not limited in their operational capacity. The SA was declared on 15 March and remained in place for 10 weeks. For the analysis, the data were grouped by consecutive calendar weeks. (3) Results. When the SA was declared the number of calls to the emergency telephone went from 1225 to 3908 calls per week (318% increase). However, the activation of the stroke code went from 6.6 to 5.0 (p = 0.04) and the activity in both stroke units decreased. The largest drop in hospitalizations was for transient ischemic attacks (TIAs) with 35.7% less, 28 vs. 18, (p = 0.05). Reperfusion therapies fell by 37.5%; Poisson regression model 0.64; (95% confidence interval (CI), 0.43–0.95). The overall activity of the telestroke suffered a reduction of 28.9%. We also observed an increase in hospital mortality. (4) Conclusion. The excessive duration of the pandemic precludes any hope of resolving this public health crisis in the short or medium term. Further studies should be conducted to better understand the multifactorial nature of this dramatic decline in stroke admissions and its negative impact.

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

“…8, Twenty-four studies met criteria for 'good' quality and 13 met criteria for 'fair' quality (Supplemetary Tables 2-4). 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]…”

“But it's a nice compromise” – Qualitative multi‐centre study of barriers and facilitators to acute telestroke cooperation in a regional stroke network

“…We are aware of several studies both nationally [31–33] as well as internationally [34–37] reporting declines in stroke incidence and/or telestroke consultations during government‐mandated lockdowns. As our data collection ended before the SARS‐CoV‐2 pandemic began, we cannot provide direct insights as to how our findings might have changed during 2020 and 2021.…”

“…We are aware of several studies both nationally [31][32][33] as well as internationally [34][35][36][37] reporting declines in stroke incidence and/or telestroke consultations during government-mandated lockdowns.…”

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

“…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.…”