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. 2020 Aug;51(8):2315-2321.
doi: 10.1161/STROKEAHA.120.030481. Epub 2020 Jun 12.

Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era

Henrique Diegoli  1 , Pedro S C Magalhães  1 , Sheila C O Martins  2 , Carla H C Moro  1 , Paulo H C França  3 , Juliana Safanelli  4 , Vivian Nagel  4 , Vanessa G Venancio  4 , Rafaela B Liberato  4 , Alexandre L Longo  1
Affiliations

Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era

Henrique Diegoli et al. Stroke. 2020 Aug.

Abstract

Background and purpose: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil.

Methods: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019.

Results: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 (P=0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage.

Conclusions: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.

Keywords: coronavirus; epidemiology; health services research; incidence; subarachnoid hemorrhage.

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Figures

Figure 1.
Figure 1.
Stroke admissions comparing before and after coronavirus 2019 (COVID-19) with the same periods in 2019. The admission rates per 100 000 inhabitants of ischemic stroke (IS), transient ischemic attack (TIA), intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH) and strokes of unknown cause for the 30 days before and after the onset of COVID-19 are compared with the same period in 2019.
Figure 2.
Figure 2.
Stroke admissions by time period. The admission rates per 100 000 inhabitants of ischemic stroke (IS), transient ischemic attack (TIA), intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH), and strokes of unknown cause are demonstrated for each month in 2019 and the first quarter of 2020. COVID-19 indicates coronavirus 2019.
Figure 3.
Figure 3.
Time from stroke onset to admission according to time period. These graphs demonstrate the proportion of patients according to time between stroke onset to admission, stratified by 0.5-h period. Of note, the shape of the distribution is similar between periods, with a peak around 1.5 h for all groups. COVID-19 indicates coronavirus 2019.
Figure 4.
Figure 4.
Hospital admissions for mild stroke and transient ischemic attack (TIA) before and after the spread of coronavirus 2019 (COVID-19). This graph illustrates a correlation between cases diagnosed with COVID-19/100 000 inhabitants in Brazil and Joinville, and the number of patients admitted with TIA or mild stroke to a hospital in Joinville.
See this image and copyright information in PMC

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References

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