Neurological

Global decline in stroke and IV thrombolysis hospital stays at the start of the COVID-19 pandemic

A global trend towards fewer hospital admissions for stroke and intravenous thrombolysis (IVT) was seen early in the COVID-19 pandemic, according to a retrospective cross-sectional study published in Neurology.

The study’s researchers conducted a retrospective cross-sectional study on observation. They evaluated data for hospital stays of patients in 457 centers in 70 countries on 6 continents for the volume of stroke and IVT admissions during the pandemic (March 1 to June 30, 2020) and compared data with prepandemic rates (November 2019 to February 2020) ).

During the pandemic, 80,894 patients were hospitalized for stroke and 11,570 for IVT, compared with 91,373 and 13,334 immediately prior to the pandemic, respectively.

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Compared to before the pandemic, there was an 11.5% decrease in stroke hospitals during the pandemic (95% CI, -11.7% to -11.3%; P <0.0001). Stratified by geographic region, Africa recorded a decrease of 30.2%, North America 18.8%, South America 17.4%, Europe 10.0% and Asia 7.1% (all P <0.0001). Centers in Oceania reported no decrease in stroke hospitalization (-1.9%; 95% CI, -2.5% to -1.5%; P = 0.3).

The number of stroke hospital stays appeared to be recovering: Compared to the first two months of the pandemic, stroke volume increased by 9.5% in the third and fourth months (95% CI, 9.2% to 9.8%; P < 0.0001).

IVT recordings decreased by 13.2% (95% CI, -13.8% to -12.7%; P <0.0001) during the pandemic. Similar patterns were observed geographically, with South America seeing the largest decrease (24.2%), followed by Africa (23.5%), North America (14.4%), Europe (13.4%), and Asia (10.1 %), with no significant difference for centers in Oceania (-1.9%; 95% CI, -3.9% to -0.92%; P = 0.7).

The mean type was significant. Primary stroke centers had dramatically lower stroke and IVT admission rates (-17.3% and -15.5%) than comprehensive stroke centers (-10.3% and -12.6%, respectively).

Of all patients hospitalized for COVID-19, 1.48% had a stroke. The stroke prevalence in patients with COVID-19 was highest in South America (3.0%) and lowest in Oceania (0.4%). 3.3% of patients admitted to hospital with stroke had SARS-CoV-2 infections. More stroke patients in South America (8.4%) had COVID-19 and the fewest reported with infections were in Oceania (0.5%).

This study may have been limited by regional differences in the diagnosis and care of stroke and IVT.

These results suggest that stroke and IVT hospital admissions associated with the early part of the COVID-19 pandemic have declined worldwide.

Disclosure: Several authors on the study have stated links with biotech, pharmaceutical, and / or device companies. For a full list of the authors’ information, see the original reference.

reference

Nogueira RG, Qureshi MM, Abdalkader M. et al. Global Impact of COVID-19 on Stroke Care and Intravenous Thrombolysis. Neurology. Published online March 25, 2021. doi: 10.1212 / WNL.0000000000011885

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