Impact of COVID-19 pandemic on stroke admissions in Qatar

Abstract

IntroductionThe COVID-19 pandemic has resulted in a dramatic unexplained decline in hospital admissions due to acute coronary syndromes and stroke. Several theories have emerged aiming to explain this decline, mostly revolving around the fear of contracting the disease and thus avoiding hospital visits.AimsIn this study, we aim to examine the impact of the COVID-19 pandemic on stroke admissions to a tertiary care centre in Qatar.MethodsThe Hamad General Hospital stroke database was interrogated for stroke admissions between September 2019 and May 2020. The number of stroke admissions, stroke subtypes and short-term outcomes was compared between the ‘pre-COVID-19’ period (September 2019 to February 2020) and the COVID-19 pandemic period (March to May 2020).ResultsWe observed a significant decline in monthly admissions in March (157), April (128) and May (135) compared with the pre-COVID-19 6-month average (229) (p=0.024). The reduction in admissions was most evident in functional stroke mimics. The average admissions decreased from 87 to 34 per month (p=0.0001). Although there were no significant differences in admissions due to ischaemic stroke (IS), intracranial haemorrhage or transient ischaemic attacks between the two periods, we noted a relative decrease in IS due to small vessel disease and an increase in those due to large vessel atherosclerosis in March to May 2020.ConclusionsThe decline in overall stroke admissions during the COVID-19 pandemic is most likely related to concerns of contracting the infection, evidenced mainly by a decline in admissions of stroke mimics. However, a relative increase in large vessel occlusions raises suspicion of pathophysiological effects of the virus, and requires further investigation.

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

“…Data sources and study selection [5][6][7][8][9][10][11][12][13][14][15], and severe [NIHSS >15] strokes) before and during the pandemic. Wherever the mean±SD of NIHSS or onset-to-door time were not reported, they were estimated from the median and interquartile range.…”

“…[3][4][5][6] A decrease in stroke admissions during the first peak of the pandemic was reported from Asia, Europe, North and South America. [7][8][9][10][11][12][13][14] While the decrease was predominantly recorded for those with milder symptoms, presentation for all stroke subtypes decreased substantially. This was suggested by decrease in the utilization of the computed tomography perfusion based rapid processing of perfusion and diffusion (RAPID, iSchemaView, Redwood City, CA, USA) software for acute stroke imaging in a report from USA.…”

“…This was suggested by decrease in the utilization of the computed tomography perfusion based rapid processing of perfusion and diffusion (RAPID, iSchemaView, Redwood City, CA, USA) software for acute stroke imaging in a report from USA. 8,13,[15][16][17] The decrease in stroke admissions reported during the COVID-19 pandemic; however, has not been uniform, with conflicting reports from across the globe. 18 In addition, late presentation as reported by few has raised concerns that the pandemic may result in fewer patients receiving thrombolysis or endovascular thrombectomy (EVT).…”

Lessons learned in stroke care during COVID-19 pandemic and preparing for future pandemics in the MENA+ region: A consensus statement from the MENA+-SINO

“…In the MENA region, like other parts of the world, a decrease in hospital admissions of stroke patients has been observed. This was also accompanied by a decrease in mechanical thrombectomy and intravenous thrombolysis procedures [ [24] , [25] , [26] ].…”

“…[ 25 ]. In a retrospective study from Qatar, an increase in stroke due to large vessel occlusion (LVO) was found, despite the overall reduction in stroke admission as a result of decline in stroke mimics [ 26 ]. The increase in LVO can be explained in part by an increased prothrombotic state as has been described in severe COVID-19 infections.…”