Changed pattern of hospital admission in stroke during COVID-19 pandemic period in Iran: a retrospective study

Tavanaei, Roozbeh; Yazdani, Kaveh Oraii; Akhlaghpasand, Mohammadhosein; Zali, Alireza; Oraee‐Yazdani, Saeed

doi:10.1007/s10072-020-05030-z

Cited by 7 publications

(20 citation statements)

References 27 publications

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“…et al [ 54 ] 206 25 from 1st November 2019 to 7th February 2020 144 24 from 7th February to 30th April 2020 Singapore 1.25% good Tejada Meza et al [ 55 ] 492 178 March 9–May 3, 2020 304 97 December 30, 2019 - March 9, 2020 Spain 0.52% good Agarwal et al [ 56 ] 634 195 6/1/2019–2/29/2020 120 38 03/012020–05/152020 US 0.72% good Wallace et al [ 57 ] 2692 335 Jan 1–Feb 29, 2020 1225 149 Mar 20–Apr 25, 2020 US 0.85% good Wu et al [ 58 ] 2354 1199 01/24/2019 to 04/29/2019 1281 791 01/24/2020 to 04/29/2020 china 0.7% good Sevilis. et al [ 59 ] 15,226 1137 December 1, 2019, to March 15, 2020 11,105 88 March 15, 2020 to June 27, 2020 US 0.03% good Tavanaei et al [ 60 ] 190 25 2019 (Mar 1 to Jun 1) 95 18 2020 (Mar 1 to Jun 1) Iran 1.31% good Srivastava et al [ 61 ] 39,113 4576 …”

Section: Resultsmentioning

confidence: 99%

Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses

et al. 2022

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Background Apart from infecting a large number of people around the world and causing the death of many people, the COVID-19 pandemic seems to have changed the healthcare processes of other diseases by changing the allocation of health resources and changing people’s access or intention to healthcare systems. Objective To compare the incidence of endpoints marking delayed healthcare seeking in medical emergencies, before and during the pandemic. Methods Based on a PICO model, medical emergency conditions that need timely intervention was selected to be evaluated as separate panels. In a systematic literature review, PubMed was quarried for each panel for studies comparing the incidence of various medical emergencies before and during the COVID-19 pandemic. Markers of failure/disruption of treatment due to delayed referral were included in the meta-analysis for each panel. Result There was a statistically significant increased pooled median time of symptom onset to admission of the acute coronary syndrome (ACS) patients; an increased rate of vasospasm of aneurismal subarachnoid hemorrhage; and perforation rate in acute appendicitis; diabetic ketoacidosis presentation rate among Type 1 Diabetes Mellitus patients; and rate of orchiectomy among testicular torsion patients in comparison of pre-COVID-19 with COVID-19 cohorts; while there were no significant changes in the event rate of ruptured ectopic pregnancy and median time of symptom onset to admission in the cerebrovascular accident (CVA) patients. Conclusions COVID-19 has largely disrupted the referral of patients for emergency medical care and patient-related delayed care should be addressed as a major health threat.

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Section: Resultsmentioning

confidence: 99%

Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses

et al. 2022

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“…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]…”

Section: Resultsmentioning

confidence: 99%

“…2). The admission rates of all strokes were reported to have dropped maximally during the pandemic in regions of the world that were most severely affected by the pandemic like certain states of the USA (California, Texas, New York, Illinois, Georgia, Ohio, Pennsylvania, New Jersey), 31,32,41,46 Italy, 28,45 Iran, 48 and Germany. 50…”

Section: Regional Differencementioning

confidence: 99%

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

et al. 2022

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Background and Purpose There are reports of decline in the rates of acute emergency presentations during coronavirus disease 2019 (COVID-19) pandemic including stroke. We performed a meta-analysis of the impact of COVID-19 pandemic on rates of stroke presentations and on rates of reperfusion therapy.Methods Following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, we systematically searched the literature for studies reporting changes in stroke presentations and treatment rates before and during the COVID-19 pandemic. Aggregated data were pooled using meta-analysis with random-effect models.Results We identified 37 observational studies (n=375,657). Pooled analysis showed decline in rates of all strokes (26.0%; 95% confidence interval [CI], 22.4 to 29.7) and its subtypes; ischemic (25.3%; 95% CI, 21.0 to 30.0), hemorrhagic (27.6%; 95% CI, 20.4 to 35.5), transient ischemic attacks (41.9%; 95% CI, 34.8 to 49.3), and stroke mimics (45.6%; 95% CI, 33.5 to 58.0) during months of pandemic compared with the pre-pandemic period. The decline was most evident for mild symptoms (40% mild vs. 25%–29% moderate/severe). Although rates of intravenous thrombolytic (IVT) and endovascular thrombectomy (EVT) decreased during pandemic, the likelihood of being treated with IVT and EVT did not differ between the two periods, both in primary and in comprehensive stroke centers (odds ratio [OR], 1.08; 95% CI, 0.94 to 1.24 and OR, 0.95; 95% CI, 0.83 to 1.09, respectively).Conclusions Rates of all strokes types decreased significantly during pandemic. It is of paramount importance that general population should be educated to seek medical care immediately for stroke-like symptoms during COVID-19 pandemic. Whether delay in initiation of secondary prevention would affect eventual stroke outcomes in the long run needs further study.

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“…During the pandemic, the severity of stroke among patients presenting for care seems to have increased. This could be ascribed to patients with milder severity of disease refraining from going to hospitals, either because emergency departments were overwhelmed with COVID-19 cases or due to the fear of patients contracting infection at hospitals [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Did COVID-19 impact stroke services? A multicenter study

et al. 2022

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Background It has been reported that acute stroke services were compromised during COVID-19 due to various pandemic-related issues. We aimed to investigate these changes by recruiting centers from different countries. Methods Eight countries participated in this cross-sectional, observational, retrospective study by providing data from their stroke data base. We compared 1 year before to 1 year during COVID-19 as regards onset to door (OTD), door to needle (DTN), door to groin (DTG), duration of hospital stay, National Institute of Health Stroke Scale (NIHSS) at baseline, 24 h, and at discharge as well as modified Rankin score (mRS) on discharge and at 3 months follow-up. Results During the pandemic year, there was a reduction in the number of patients, median age was significantly lower, admission NIHSS was higher, hemorrhagic stroke increased, and OTD and DTG showed no difference, while DTN time was longer, rtPA administration was decreased, thrombectomy was more frequent, and hospital stay was shorter. mRS was less favorable on discharge and at 3 months. Conclusion COVID-19 showed variable effects on stroke services. Some were negatively impacted as the number of patients presenting to hospitals, DTN time, and stroke outcome, while others were marginally affected as the type of management.

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Changed pattern of hospital admission in stroke during COVID-19 pandemic period in Iran: a retrospective study

Cited by 7 publications

References 27 publications

Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses

Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses

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

Did COVID-19 impact stroke services? A multicenter study

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