Abstract
BackgroundAppropriate treatment of stroke immediately after its onset contributes to the improved chances, while delay in hospitalisation affects stroke severity and fatality. This study aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on emergency hospitalisation of patients with stroke in Japan.MethodsThis was an observational study that used nationwide administrative data of hospitalised patients diagnosed with stroke. We cross-sectionally observed patients’ background factors during April and May 2020, when the COVID-19 pandemic-related state of emergency was declared; we also observed these factors in the same period in 2019. We also modelled monthly trends in emergency stroke admissions, stroke admissions at each level of the Japan Coma Scale (JCS), fatalities within 24 h, stroke care unit use, intravenous thrombolysis administration, and mechanical thrombectomy implementation using interrupted time series (ITS) regression.ResultsThere was no difference in patients’ pre-hospital baseline characteristics between the pre-pandemic and pandemic periods. However, ITS regression revealed a significant change in the number of emergency stroke admissions after the beginning of the pandemic (slope: risk ratio [RR] = 0.97, 95% confidence interval [CI]: 0.95–0.99, P = 0.027). There was a significant difference in the JCS score for impaired consciousness in emergency stroke, which was more severe during the pandemic than the pre-pandemic (JCS3 in level: RR = 1.75, 95% CI: 1.29–2.33, P < 0.001). There was no change in the total number of fatalities with COVID-19, compared with those without COVID-19, but there were significantly more fatalities within 24 h of admission (fatalities within 24 h: RR = 1.75, 95% CI: 1.29–2.33, P < 0.001).ConclusionsThe infection prevalence of COVID-19 increased the number of fatalities within 24 h as well as the severity of illness in Japan. However, there was no difference in baseline characteristics, intravenous thrombolysis administration, and mechanical thrombectomy implementation during the COVID-19 pandemic. A decrease in the number of patients and fatalities was observed from the time the state of emergency was declared until August, the period of this study.
Highlights
Appropriate treatment of stroke immediately after its onset contributes to the improved chances, while delay in hospitalisation affects stroke severity and fatality
Appropriate treatment, such as administration of intravenous thrombolysis (IVT) and implementation of mechanical thrombectomy (MT), immediately after the onset of stroke can contribute to the improved chances of survival; the time of access to the hospital from the onset of stroke is critical [8,9,10,11]
One previous study aimed to clarify the effects of the COVID-19 pandemic in a comprehensive stroke centre in Japan; the results showed that true emergencies appear to be associated with fewer emergency hospital visits and hospitalisations for stroke [15]
Summary
Appropriate treatment of stroke immediately after its onset contributes to the improved chances, while delay in hospitalisation affects stroke severity and fatality. Healthcare delivery for stroke can be considered to be strongly influenced by COVID-19 infection [7] Appropriate treatment, such as administration of intravenous thrombolysis (IVT) and implementation of mechanical thrombectomy (MT), immediately after the onset of stroke can contribute to the improved chances of survival; the time of access to the hospital from the onset of stroke is critical [8,9,10,11]. Since the delay in hospitalisation from the onset of stroke may affect severity and fatality, it is important to understand the emergency hospitalisation status of patients with stroke due to COVID-19 infection
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