Impact of the COVID-19 outbreak on acute stroke care

Rinkel, Leon A; Prick, Janine; Slot, Rosalinde E.R.; Sombroek, N. M. A.; Burggraaff, Jessica; Groot, Adrien E.; Emmer, Bart J.; Roos, Yvo B.W.E.M.; Brouwer, Matthijs C.; Berg-Vos, Renske M. Van den; Majoie, Charles B. L. M.; Beenen, Ludo F. M.; Beek, Diederik van de; Visser, Marieke C.; Schaik, Sander M. Van; Coutinho, Jonathan M.

doi:10.1007/s00415-020-10069-1

Cited by 77 publications

(95 citation statements)

References 16 publications

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“…A study of a network of health care organizations in over 30 countries showed a 25–43% decrease in the number of patients with stroke during the pandemic [ 26 ]. A study in hospitals in the Amsterdam area showed a 24% decrease in the number of patients with a suspected stroke during the height of the COVID19 pandemic, compared to a pre-COVID19 control period [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction

Jain

Berkenbush

Feldman

et al. 2021

The American Journal of Emergency Medicine

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Objective: The Novel Coronavirus19 (COVID19) arrived in northern New Jersey (NJ) in early March 2020, peaked at the beginning of April, and then declined. Starting in March, some patients who called 911 and required advanced life support (ALS) may have decompensated more rapidly than would have been expected, possibly because of concomitant COVID19 infection and/or delays in seeking medical care because of fear of exposure to the virus, and social isolation. In this study, our goal was to determine if there was an increase in prehospital ALS pronouncements and a decrease in ED visits for potentially serious conditions such as MI and stroke during the peak of the COVID-19 pandemic in northern NJ. Methods study design: Retrospective cohort of prehospital patients pronounced dead by paramedics and patients with MI and stroke in the EDs of receiving hospitals of these paramedics. Study Setting and Population: Ten ground ALS units in northern NJ and nine receiving hospital EDs. Each ALS unit is staffed by two NJ-certified mobile intensive care paramedics and respond with a paramedic flycar in a two-tiered dispatch system. Data Analysis: We identified prehospital pronouncements using the EMSCharts electronic record (Zoll Medical, Chelmsford, Massachusetts). We tabulated the number of pronouncements by week from January 1 to June 30 in 2019 and 2020. We tabulated the combined total number of pronouncements and ED visits by month along with visits for MI and stroke and calculated the changes during the same timeframe. We used Chi-square to test for statistical significance for the monthly changes from 2019 to 2020. Results: For January through June in 2019 and 2020, there were 12,210 and 13,200 ALS dispatches, and 366 and 555 prehospital pronouncements, respectively. In 2020, pronouncements rose from a weekly baseline of 13 in early March, reached a peak of 45 at the beginning of April, then returned to the baseline level by the end of May. April 2020, the month with the most pronouncements, had 183% more pronouncements than April 2019 but total ED visits and visits for MI and stroke were 49%, 46% and 42% less, respectively (p < 0.0001 for each of these changes). Conclusion: Following the arrival of the COVID-19 pandemic in northern NJ, we found pre-hospital ALS death pronouncements increased and ED visits for MI and stroke decreased. Although we have speculated about the reasons for these findings, further studies are needed to determine what the actual causes were.

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Section: Resultsmentioning

confidence: 99%

Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction

Jain

Berkenbush

Feldman

et al. 2021

The American Journal of Emergency Medicine

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“…This finding is may potentially be explained by misdiagnosed or underdiagnosed stroke during lockdown. Accordingly, Rinkel et al observed a 24% decrease in suspected stroke presentation during the lockdown period in the Netherlands [23]. The decrease in numbers of death due to other reasons during the lockdown period in 2020 compared with the non-pandemic period in 2019 might be explained by the fact that during the lockdown period there were fewer traffic accidents [24] and less crime [25].…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study

et al. 2020

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Aims During the COVID-19 pandemic, hospital admissions for cardiac care have declined. However, effects on mortality are unclear. Thus, we sought to evaluate the impact of the lockdown period in central Germany on overall and cardiovascular deaths. Simultaneously we looked at catheterization activities in the same region. Methods and results Data from 22 of 24 public health-authorities in central Germany were aggregated during the pandemic related lockdown period and compared to the same time period in 2019. Information on the total number of deaths and causes of death, including cardiovascular mortality, were collected. Additionally, we compared rates of hospitalization (n = 5178) for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and out of hospital cardiac arrest (OHCA) in 26 hospitals in this area. Data on 5,984 deaths occurring between March 23, 2020 and April 26, 2020 were evaluated. In comparison to the reference non-pandemic period in 2019 (deaths: n = 5832), there was a non-significant increase in all-cause mortality of 2.6% [incidence rate ratio (IRR) 1.03, 95% confidence interval (CI) 0.99–1.06; p = 0.16]. Cardiovascular and cardiac mortality increased significantly by 7.6% (IRR 1.08, 95%-CI 1.01–1.14; p = 0.02) and by 11.8% (IRR 1.12, 95%-CI 1.05–1.19; p < 0.001), respectively. During the same period, our data revealed a drop in cardiac catherization procedures. Conclusion During the COVID-19-related lockdown a significant increase in cardiovascular mortality was observed in central Germany, whereas catherization activities were reduced. The mechanisms underlying both of these observations should be investigated further in order to better understand the effects of a pandemic-related lockdown and social-distancing restrictions on cardiovascular care and mortality. Graphic abstract

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“…Another problem may have been that awareness of stroke warning signs and symptoms among our emergency department colleagues who should activate the stroke code or call neurologists may be suboptimal due to excessive replacement of frontline staff or a preferential effort to prioritize pandemic care [ 22 ]. This could also have been the case in the emergency departments of the smaller hospitals in the network and would further explain why stroke activity was dramatically reduced [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

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

Ramírez-Moreno

Portilla-Cuenca

Hariramani-Ramchandani

et al. 2021

Brain Sciences

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(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.

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Impact of the COVID-19 outbreak on acute stroke care

Cited by 77 publications

References 16 publications

Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction

Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction

Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study

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

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