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. 2021 Apr;16(3):735-739.
doi: 10.1007/s11739-020-02522-w. Epub 2020 Oct 15.

Request of hospital care dropped for TIA but remained stable for stroke during COVID-19 pandemic at a large Italian university hospital

Maurizio Balestrino  1   2 , Alberto Coccia  3   4 , Alessandra Silvia Boffa  3 , Andrea Furgani  5 , Francesco Bermano  5 , Cinzia Finocchi  3   4 , Monica Laura Bandettini di Poggio  3   4 , Laura Malfatto  4 , Daniele Farinini  4 , Angelo Schenone  3   4
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Request of hospital care dropped for TIA but remained stable for stroke during COVID-19 pandemic at a large Italian university hospital

Maurizio Balestrino et al. Intern Emerg Med. 2021 Apr.

Abstract

Reduced incidence of stroke during COVID-19 pandemic was sometimes reported. While decrease in stroke incidence and fear of patients to go to the hospitals were sometimes invoked to explain this decrease, reduction in urban pollution was also hypothesized as a possible cause. We investigated statistically the incidence of ischemic and hemorrhagic stroke, and of transient ischemic attacks, at a large Italian tertiary stroke center during the pandemic. We analyzed statistically the number of transient ischemic attacks (TIA), ischemic strokes (IS) and hemorrhagic strokes (HS) between March 8 and May 2, 2020, the peak of the COVID-19 epidemic in Italy, and compared them with the identical period of 2019. We also analyzed the concentration of small particulate matter (PM10) in 2019 and 2020, to see if it could account for modified incidence of strokes or TIA. We found a large, significant drop in TIA (- 51%) during the pandemic compared to the same period of 2019. By contrast, the number of HS was identical, and IS showed a not significant - 24% decrease. PM10 concentration, already low in 2019, did not further decrease in 2020. Patients kept seeking hospital care when experiencing permanent neurological symptoms (stroke), but they tended not go to the hospital when their symptoms were transient (TIA). The fact that we did not observe a significant decrease in strokes may be explained by the fact that in our city the concentration of small particulate matter did not change compared to 2019.

Keywords: COVID-19; Hemorrhagic stroke; Hospital care; Ischemic stroke; Stroke; Transient ischemic attack.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Weekly incidence of the various conditions. For 2020, we provide both the total numbers of ischemic and hemorrhagic strokes we observed, and the numbers of only those patients that came from within the usual catchment area of our hospital. Since TIA patients were not usually carried by ambulance, their number was unaffected by the reorganization of emergency services that took place in 2020. See text and Table 1 for further details
See this image and copyright information in PMC

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