Impact of COVID-19 on Hospital Admission of Acute Stroke patients in Bangladesh

  1. A T M Hasibul Hasan
  2. Subir Chandra Das
  3. Muhammad Sougatul Islam
  4. Mohaimen Mansur
  5. Md Shajedur Rahman Shawon
  6. Rashedul Hassan
  7. Mohammad Shah Jahirul Hoque Chowdhury
  8. Md Badrul Alam Mondal
  9. Quazi Deen Mohammad

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Abstract

Background

With the proposed pathophysiologic mechanism of neurologic injury by SARS COV-2 the frequency of stroke and henceforth the related hospital admissions were expected to rise. In this paper we investigate this presumption by comparing the frequency of admissions of stroke cases in Bangladesh before and during the pandemic.

Methods

We conducted a retrospective analysis of stroke admissions in a 100-bed stroke unit at the National Institute of Neurosciences and Hospital (NINS&H) which is considerably a large stroke unit. We considered all the admitted cases from the 1 st January to the 30 th June, 2020. We used Poisson regressions to determine whether statistically significant changes in admission counts can be found before and after 25 March since when there is a surge in COVID-19 infections.

Results

A total of 1394 stroke patients got admitted during the study period. Half of the patients were older than 60 years, whereas only 2.6% were 30 years old or younger with a male-female ratio of 1.06:1. From January to March, 2020 the mean rate of admission was 302.3 cases per month which dropped to 162.3 cases per month from April to June with an overall reduction of 46.3% in acute stroke admission per month. In those two periods, reductions in average admission per month for ischemic stroke (IST), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and venous stroke (VS) were 45.5%, 37.2%, 71.4% and 39.0%, respectively. Based on weekly data, results of Poisson regressions confirm that the average number of admissions per week dropped significantly during the last three months of the sample period. Further, in the first three months, a total of 22 cases of hyperacute stroke management were done whereas in the last three months there was an 86.4% reduction in the number of hyperacute stroke patients getting reperfusion treatment. Only 38 patients (2.7%) were later found to be RT- PCR for SARS Cov-2 positive based on nasal swab testing.

Conclusion

Our study revealed more than fifty percent reduction in acute stroke admission during the COVID-19 pandemic. It is still elusive whether the reduction is related to the fear of getting infected by COVID-19 from hospitalization or the overall restriction on public movement and stay-home measures.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.28.316448: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: Ethical Issues: Prior to the commencement of the study, the protocol was reviewed and approved by the Ethical Review Committee (ERC), National Institute of Neurosciences and Hospital.
    Consent: The authority provided fully anonymized data and the need for the informed consent was also waived by the ERC due to the retrospective nature of the study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableMale and female patients of age 18 years or above who have confirmed diagnosis of stroke were admitted in the stroke unit.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data analysis was done by Statistical Package for Social Sciences (SPSS) version 21 and R version 4.0.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    We had a few limitations in this study. First of all, this is a retrospective analysis based on hospital records. Therefore, available information were of limited value and further analyses such as investigating reasons behind the reduction in stroke admissions were not possible. Secondly, since the stroke unit at NINS&H started its journey only in September 2019, we could not compare stroke admissions during 2020 with the same time periods of the year 2019, which would have been a more fare comparison devoid of any possible seasonal effects on admission. The major strength of the study, however, is that we could analyze a considerable number of admitted stroke cases over substantially long periods before and during the COVID-19 pandemic. Importantly, the data came from one of the largest stroke units in the world and the highest center of referral for stroke cases in Bangladesh that provides a comprehensive stroke care 24×7.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.09.28.316448 on bioRxiv