The Change in Acute Ischemic Stroke Numbers in the Emergency Service During Early Phase of COVID -19 Pandemic
Yıl 2022,
Cilt: 8 Sayı: 1, 139 - 145, 25.02.2022
Abdussamed Vural
,
İskender Aksoy
,
Mehmet Ekiz
Öz
Objective: Although the actual relationship between COVID -19 and the incidence of stroke has not yet been clearly defined, various potential mechanisms such as hypercoagulation or viral infecton burden have been reported as risk factors that can increase the risk of stroke. However, various anecdotal reports have emphasized the falling rate of new ischemic stroke diagnoses during period of COVID-19. This study was conducted to estimate the change in the number of new stroke diagnoses and evaluate the approximate causes of such situations during the early period of the COVID-19 outbreak.
Methods: In this retrospective observational descriptive study, the patients were divided into two groups as January-February 2020 (Pre-COVID−19) and March-April 2020 (COVID-19 Period), based on when the first COVID-19 case was reported in Turkey in March 2020. Patients who were admitted to the emergency department (ED) between 01 January 2019 and 30 April 2019 and diagnosed with ischemic cerebrovascular disease were included as the control group to estimate the number of cases predicted for 2020. The data of the groups were retrospectively analyzed in terms of the number of stroke admissions and demographic features.
Results: Among the 274 patients diagnosed with acute ischemic stroke during the 4-month study period, 112 (40.9%) were detected during the COVID-19 period. Considering the linear relationship between the number of patients diagnosed with ischemic stroke in January-February 2019 and March-April 2019 in the control group of the study, this number was expected to be 163 in March-April 2020, since the number of patients with ischemic stroke diagnosed in January-February 2020 was 162. While it was determined that a 25.35% decrease had occurred in January-February 2020 compared to the January-February 2019, it was determined that a 48.9% decrease had occurred in March-April 2020 compared to the same period of the previous year.
Conclusion: This study showed that the number of patients admitted to the hospital with a diagnosis of ischemic stroke in the March-April 2020 decreased statistically significantly compared to the pre-pandemic period of the same year.
Kaynakça
- 1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y. et. al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
- 2. Sohrabi C, Alsafi Z, O'Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6.
- 3. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
- 4. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
- 5. Aubignat M, Godefroy O. COVID-19 and ischemic stroke: Should we systematically look for lupus anticoagulant and antiphospholipid antibodies? Rev Neurol (Paris). 2020;176(6):505-6.
- 6. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-90.
- 7. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. Journal of the European Academy of Dermatology and Venereology. 2020;34(5):e212-e213.
- 8. National Institute of Neurological Disorders and stroke. (2020). Stroke Definition. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Stroke-Information-Page Accessed June 1, 2020.
- 9. Grysiewicz RA, Thomas K, Pandey DK. Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurologic clinics. 2008;26(4):871-95.
- 10. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ; HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4.
- 11. Steen Krawcyk R, Vinther A, Petersen NC, Faber J, Rehman S, Iversen HK, et al. Self-Reported Physical Activity and Cardiovascular Disease Risk Factors in Patients with Lacunar Stroke. J Stroke Cerebrovasc Dis. 2019;28(8):2168-76.
- 12. Patnode CD, Evans CV, Senger CA, Redmond N, Lin JS. Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017;318(2):175-193.
- 13. Desikan A. Outdoor air pollution as a possible modifiable risk factor to reduce mortality in post-stroke population. Neural regeneration research. 2017;12(3):351-3.
- 14. Béjot Y, Reis J, Giroud M, Feigin V. A review of epidemiological research on stroke and dementia and exposure to air pollution. International journal of stroke. 2018;13(7):687-95.
- 15. Markus HS, Brainin M. COVID-19 and stroke-A global World Stroke Organization perspective. International Journal of Stroke. 2020;15(4):361-4.
- 16. Stroke Care and the COVID19 Pandemic Words from our President. https://www.world- Accessed June 2 , 2020.
- 17. WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/ Accessed January 6, 2022.
- 18. Belani P, Schefflein J, Kihira S, Rigney B, Delman BN, Mahmoudi K, et al. COVID-19 Is an Independent Risk Factor for Acute Ischemic Stroke. AJNR Am J Neuroradiol. 2020;41(8):1361-4.
- 19. Sharma M, Lioutas VA, Madsen T, Clark J, O'Sullivan J, Elkind MSV, et al. Decline in stroke alerts and hospitalisations during the COVID-19 pandemic. Stroke Vasc Neurol. 2020;5(4):403-5.
- 20. Schirmer CM, Ringer AJ, Arthur AS, Binning MJ, Fox WC, James RF, et al. Delayed presentation of acute ischemic strokes during the COVID-19 crisis. J Neurointerv Surg. 2020;12(7):639-42.
- 21. Siegler JE, Heslin ME, Thau L, Smith A, Jovin TG. Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center. Journal of Stroke and Cerebrovascular Disease. 2020;29(8):104953.
- 22. Hedna VS, Bodhit AN, Ansari S, Falchook AD, Stead L, Heilman KM, Waters MF. Hemispheric differences in ischemic stroke: is left-hemisphere stroke more common? Journal of Clinical Neurology. 2013;9(2):97-102.
- 23. Portegies ML, Selwaness M, Hofman A, Koudstaal PJ, Vernooij MW, Ikram MA. Left-sided strokes are more often recognized than right-sided strokes: the Rotterdam study. Stroke. 2015;46(1):252-4
The Change in Acute Ischemic Stroke Numbers in the Emergency Service During Early Phase of COVID -19 Pandemic
Yıl 2022,
Cilt: 8 Sayı: 1, 139 - 145, 25.02.2022
Abdussamed Vural
,
İskender Aksoy
,
Mehmet Ekiz
Öz
Objective: Although the actual relationship between COVID -19 and the incidence of stroke has not yet been clearly defined, various potential mechanisms such as hypercoagulation or viral infecton burden have been reported as risk factors that can increase the risk of stroke. However, various anecdotal reports have emphasized the falling rate of new ischemic stroke diagnoses during period of COVID-19. This study was conducted to estimate the change in the number of new stroke diagnoses and evaluate the approximate causes of such situations during the early period of the COVID-19 outbreak.
Methods: In this retrospective observational descriptive study, the patients were divided into two groups as January-February 2020 (Pre-COVID−19) and March-April 2020 (COVID-19 Period), based on when the first COVID-19 case was reported in Turkey in March 2020. Patients who were admitted to the emergency department (ED) between 01 January 2019 and 30 April 2019 and diagnosed with ischemic cerebrovascular disease were included as the control group to estimate the number of cases predicted for 2020. The data of the groups were retrospectively analyzed in terms of the number of stroke admissions and demographic features.
Results: Among the 274 patients diagnosed with acute ischemic stroke during the 4-month study period, 112 (40.9%) were detected during the COVID-19 period. Considering the linear relationship between the number of patients diagnosed with ischemic stroke in January-February 2019 and March-April 2019 in the control group of the study, this number was expected to be 163 in March-April 2020, since the number of patients with ischemic stroke diagnosed in January-February 2020 was 162. While it was determined that a 25.35% decrease had occurred in January-February 2020 compared to the January-February 2019, it was determined that a 48.9% decrease had occurred in March-April 2020 compared to the same period of the previous year.
Conclusion: This study showed that the number of patients admitted to the hospital with a diagnosis of ischemic stroke in the March-April 2020 decreased statistically significantly compared to the pre-pandemic period of the same year.
Kaynakça
- 1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y. et. al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
- 2. Sohrabi C, Alsafi Z, O'Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6.
- 3. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
- 4. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
- 5. Aubignat M, Godefroy O. COVID-19 and ischemic stroke: Should we systematically look for lupus anticoagulant and antiphospholipid antibodies? Rev Neurol (Paris). 2020;176(6):505-6.
- 6. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-90.
- 7. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. Journal of the European Academy of Dermatology and Venereology. 2020;34(5):e212-e213.
- 8. National Institute of Neurological Disorders and stroke. (2020). Stroke Definition. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Stroke-Information-Page Accessed June 1, 2020.
- 9. Grysiewicz RA, Thomas K, Pandey DK. Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurologic clinics. 2008;26(4):871-95.
- 10. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ; HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4.
- 11. Steen Krawcyk R, Vinther A, Petersen NC, Faber J, Rehman S, Iversen HK, et al. Self-Reported Physical Activity and Cardiovascular Disease Risk Factors in Patients with Lacunar Stroke. J Stroke Cerebrovasc Dis. 2019;28(8):2168-76.
- 12. Patnode CD, Evans CV, Senger CA, Redmond N, Lin JS. Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017;318(2):175-193.
- 13. Desikan A. Outdoor air pollution as a possible modifiable risk factor to reduce mortality in post-stroke population. Neural regeneration research. 2017;12(3):351-3.
- 14. Béjot Y, Reis J, Giroud M, Feigin V. A review of epidemiological research on stroke and dementia and exposure to air pollution. International journal of stroke. 2018;13(7):687-95.
- 15. Markus HS, Brainin M. COVID-19 and stroke-A global World Stroke Organization perspective. International Journal of Stroke. 2020;15(4):361-4.
- 16. Stroke Care and the COVID19 Pandemic Words from our President. https://www.world- Accessed June 2 , 2020.
- 17. WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/ Accessed January 6, 2022.
- 18. Belani P, Schefflein J, Kihira S, Rigney B, Delman BN, Mahmoudi K, et al. COVID-19 Is an Independent Risk Factor for Acute Ischemic Stroke. AJNR Am J Neuroradiol. 2020;41(8):1361-4.
- 19. Sharma M, Lioutas VA, Madsen T, Clark J, O'Sullivan J, Elkind MSV, et al. Decline in stroke alerts and hospitalisations during the COVID-19 pandemic. Stroke Vasc Neurol. 2020;5(4):403-5.
- 20. Schirmer CM, Ringer AJ, Arthur AS, Binning MJ, Fox WC, James RF, et al. Delayed presentation of acute ischemic strokes during the COVID-19 crisis. J Neurointerv Surg. 2020;12(7):639-42.
- 21. Siegler JE, Heslin ME, Thau L, Smith A, Jovin TG. Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center. Journal of Stroke and Cerebrovascular Disease. 2020;29(8):104953.
- 22. Hedna VS, Bodhit AN, Ansari S, Falchook AD, Stead L, Heilman KM, Waters MF. Hemispheric differences in ischemic stroke: is left-hemisphere stroke more common? Journal of Clinical Neurology. 2013;9(2):97-102.
- 23. Portegies ML, Selwaness M, Hofman A, Koudstaal PJ, Vernooij MW, Ikram MA. Left-sided strokes are more often recognized than right-sided strokes: the Rotterdam study. Stroke. 2015;46(1):252-4