Negative Impact of the COVID-19 Pandemic on Admissions for Intracranial Hemorrhage

Abstract

Background: The COVID-19 pandemic has seriously impacted healthcare systems worldwide. Admissions for various non-COVID-19 emergencies have significantly decreased. We sought to determine the impact of COVID-19 on admissions for intracranial hemorrhage to a German University Hospital emergency department. Methods: In a retrospective analysis of admissions to the emergency department of the University Hospital Mannheim from January to June 2020 and the corresponding time period in 2019, all patients admitted for either traumatic or non-traumatic intracranial hemorrhage were evaluated. Poisson regression was performed to analyze changes in admission rates as a function of year, epoch (COVID-19-epoch, March to April 2020 and corresponding months 2019; non-COVID-19-epoch, January to February and May to June 2019/2020) and the interaction of year and epoch (reflecting the impact of the pandemic and subsequent lockdown measures). Results: Overall, 320 patients were included in the study. During the COVID-19-epoch, admission rates for spontaneous intracranial hemorrhage decreased significantly by 42.1% (RR 0.579, p = 0.002, 95% confidence interval 0.410-0.818). Likewise, admission rates for traumatic intracranial hemorrhage decreased significantly by 53.7% [RR = 0.463, p < 0.001, 95% confidence interval (CI) 0.358-0.599]. Conclusion: The decrease of spontaneous intracranial hemorrhages may be a consequence of underutilization of the healthcare system whereas decreasing rates of traumatic intracranial hemorrhage admissions may predominantly reflect a decrease in true incidence rates due to lockdown measures with restricted mobility. Raising patient awareness to seek emergency healthcare for acute neurological deficits during lockdown measures is important to ensure appropriate emergency care for patients with intracranial hemorrhage.

Differential effects of the SARS‐CoV‐2 pandemic on patients presenting to a neurological emergency room depending on their triage score in an area with low COVID‐19 incidence

“…Our finding of a decreasing number of patients presenting to the nER is in line with previously reported studies [6,7,14,15].…”

“…Our finding of a decreasing number of patients presenting to the nER is in line with previously reported studies [6,7,14,15]. A distinctive feature of our study compared to other studies is that the number of COVID‐19 cases in our region was relatively low, even compared to other regions in Germany.…”

A meta‐analysis of the global impact of the COVID‐19 pandemic on stroke care & the Houston Experience

“…A total of 52 studies reporting the impact of the COVID‐19 pandemic on stroke admissions were identified for qualitative synthesis. A total of 32,640 stroke admissions from 29 studies 6‐34 were included in the meta‐analysis (Figure 1) (Supplementary Table S1) based on a similar time frame of the study period and comparison period, of which ratios were derived, depending on each criterion data availability. Compared to the prepandemic period, the mean ratio of stroke admissions during the pandemic was 70.78% [95% CI: (65.02%, 76.54%)] (Figure 2) and the mean ratio of ICH cases was 83.10% [95% CI: (71.01%, 95.17%)] (Supplementary Figure S1).…”

Intracerebral hemorrhage during the pandemic- Learning from experience

“…10 The increase in the number of ICH cases in the first wave compared to the pre-pandemic period was intriguing because worldwide, there was a reduction in ICH cases during the first wave. 1,11 Reduced access to health care due to restrictions created by lockdown and fear of getting infected, hypertensive patients would have poor control of hypertension which may have contributed to the rise in ICH. ICH strokes would have caused more severe strokes (as evidenced by higher NIHSS) due to which patients were forced to attend hospitals which may be another reason for the increase in the number of ICH cases.…”