Stroke admission rates before, during and after the first phase of the COVID-19 pandemic

Kristoffersen, Espen Saxhaug; Jahr, Silje Holt; Faiz, Kashif Waqar; Thommessen, Bente; Rønning, Ole Morten

doi:10.1007/s10072-021-05039-y

Cited by 14 publications

(19 citation statements)

References 20 publications

(61 reference statements)

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“…The initial decrease in stroke presentations was followed by a rebound of 77% in the period May-June. The initial decrease in cases was like that reported in the literature (15,17–22,24–28,34–39). We saw a reduction in stroke presentations despite a relatively low incidence of SARS-CoV-2 infections compared to other centres internationally.…”

Section: Discussionsupporting

confidence: 82%

Change in stroke presentations during COVID-19 pandemic in South-Western Sydney

Thomas

Cordato

Manser

et al. 2022

Preprint

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Background: Australia managed relatively well during the global COVID-19 pandemic owing to our swift mandated public health response. During the NSW lockdown restrictions, we noted a decrease in acute stroke presentations at our institution, similar to what was subsequently reported worldwide. Aims: We aimed to test our hypothesis that (i) the true numbers of ischaemic strokes did not change, however patients were presenting later and (ii) the proportion of TIAs decreased. Methods: We conducted a retrospective audit of all stroke and TIA presentations in 2020 and compared these with data from 2019. We collected information about stroke subtype, severity, time from stroke/TIA onset to presentation and acute reperfusion therapies. Results: Between January-February and April-March 2020, there was a 15% drop in acute stroke presentations (128 vs. 109). In the same period "stroke mimic" presentations dropped by 22%. The proportion of patients attending the emergency department within 4.5hrs was only 36% compared with 48% over the similar period in 2019. Conclusions: Although the raw numbers of ischemic stroke presentations remained stable during NSW Covid lockdown, the proportion of patients presenting within time window for acute reperfusion therapies fell. The number of TIAs similarly fell suggesting COVID-19 discouraged patients from presenting to hospital which placed them at higher risk of disabling stroke. The opportunity cost of lockdown restrictions on stroke outcome should be considered in future policy directives.

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Section: Discussionsupporting

confidence: 82%

Change in stroke presentations during COVID-19 pandemic in South-Western Sydney

Thomas

Cordato

Manser

et al. 2022

Preprint

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“…The aforementioned reports' proposed explanations of their corresponding findings share a common theme in hypothesizing possible reluctance in seeking medical care upon warning signs of SAH, due to a perceived risk of contracting COVID-19 by the general public. Similar results and explanations have been reported with regards to hospital admissions due to myocardial infarction and stroke in the COVID-19 era [17][18][19]. It is worth noting that there are certain limitations relative to study design.…”

Section: Discussionsupporting

confidence: 81%

Effects of COVID-19 on the admissions of aneurysmal subarachnoid hemorrhage: the West Greece experience

et al. 2021

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Background Acute subarachnoid hemorrhage (SAH) due to aneurysmal rupture is a devastating vascular disease accounting for 5% of strokes. COVID-19 pandemic resulted in a decrease in elective and emergency admissions in the majority of neurosurgical centers. The main hypothesis was that fear of COVID-19 may have prevented patients with critical medical or surgical emergencies from actively presenting in emergency departments and outpatient clinics. Methods We conducted a single-center, retrospective, observational study searching our institutional data regarding the incidence of spontaneous subarachnoid hemorrhage (SAH) and compare the admissions in two different periods: the pre COVID-19 with the COVID-19 period. Results The study cohort was comprised of a total of 99 patients. The mean (SD) weekly case rate of patients with SAH was 1.1 (1.1) during the pre-COVID-19 period, compared to 1.7 (1.4) during the COVID-19 period. Analysis revealed that the volume of admitted patients with SAH was 1.5-fold higher during the COVID period compared to the pre-COVID period and this was statistically significant (ExpB = 1.5, CI 95% 1-2.3, p = 0.044). Difference in mortality did not reach any statistical significance between the two periods (p = 0.097), as well as patients' length of stay (p = 0.193). Conclusions The presented data cover a more extended time period than so far published reports; it is reasonable that our recent experience may well be demonstrating a general realistic trend of overall increase in aneurysmal rupture rates during lockdown. Hospitalization of patients with SAH cannot afford any reductions in facilities, equipment, or personnel if optimum outcomes are desirable.

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“…On the other hand, necessary urgent treatment of serious conditions, such as acute stroke, acute seizures, glioblastoma and immune-mediated polyneuropathies, was reported to be virtually unchanged during the first weeks of the pandemic. In Norway, as in Germany, a decrease in the absolute thrombolysis treatment numbers has been reported, but with similar treatment rates compared with previous months for those with ischemic stroke that presented to hospital within the thrombolysis time window [16][17][18].…”

Section: Discussionmentioning

confidence: 77%

Experiences, distress and burden among neurologists in Norway during the COVID-19 pandemic

et al. 2021

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Background The ongoing COVID-19 pandemic has caused rapid changes in the healthcare system. Workforce reorganization, reduced standard of care and a lack of personal protection equipment (PPE) for health care workers were among the concerns raised in the first wave of the pandemic. Our aim was to explore the experiences, distress and burden among Norwegian neurologists during the first weeks of the pandemic. Methods Hospital-based neurologists in Norway (n = 400) were invited to a web-based survey in April 2020. The study focused on patient management, organizational changes and personal stress during the first weeks of the pandemic lockdown. Work-home interface stress was assessed by the Cooper Job Stress Questionnaire. Results In total, 135 neurologists participated. Seventy-three% experienced a change in their personal work situation, and 67% examined patients with suspected COVID-19 infection and neurological disease. Changed access to resources, and the perception that medical follow-up was unsatisfactory, were associated with a high degree of burden and stress. Neurologists were also worried about the potential lack of PPE and the fear of spreading SARS CoV-2 to close family members. The mean score of work-home interface stress was 2.8 with no significant differences between gender or specialist status. Reduced standard of care was reported for all neurological conditions, and in particular for non-emergency treatments. Conclusion The vast majority of neurologists in Norway experienced a change in their personal work situation during the first phase of the pandemic. The fear of becoming infected and ill was not a major contributor to burden and stress.

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Stroke admission rates before, during and after the first phase of the COVID-19 pandemic

Cited by 14 publications

References 20 publications

Change in stroke presentations during COVID-19 pandemic in South-Western Sydney

Change in stroke presentations during COVID-19 pandemic in South-Western Sydney

Effects of COVID-19 on the admissions of aneurysmal subarachnoid hemorrhage: the West Greece experience

Experiences, distress and burden among neurologists in Norway during the COVID-19 pandemic

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