The decrease in hospitalizations for transient ischemic attack and ischemic stroke, especially in mild cases, during the COVID-19 epidemic in Japan

  1. Hiroyuki Nagano
  2. Daisuke Takada
  3. Jung-ho Shin
  4. Tetsuji Morishita
  5. Susumu Kunisawa
  6. Yuichi Imanaka

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Abstract

Background and Purpose

The epidemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study was to assess the impact of the COVID-19 epidemic on hospital admissions for stroke in Japan.

Methods

We analyzed administrative (Diagnosis Procedure Combination) data for cases of inpatients aged 18 years and older who were diagnosed with stroke (ischemic stroke, transient ischemic attack (TIA), hemorrhagic stroke, or subarachnoid hemorrhage (SAH)) and discharged from hospital during the period July 1, 2018 to June 30, 2020. The number of patients with each stroke diagnosis, various patient characteristics, and treatment approaches were compared before and after the epidemic. Changes in the trend of the monthly number of inpatients with each stroke diagnosis were assessed using interrupted time-series analyses.

Results

A total of 111,922 cases (ischemic stroke: 74,897 cases; TIA: 5,374 cases; hemorrhagic stroke: 24,779 cases; SAH: 6,872 cases) in 253 hospitals were included. The number of cases for all types of stroke decreased (ischemic stroke: -13.9%; TIA: -21.4%; hemorrhagic stroke: -9.9%; SAH: -15.2%) in April and May 2020, compared to the number of cases in 2019. Ischemic stroke and TIA cases, especially mild cases (modified Rankin Scale = 0), decreased, with a statistically significant change in trend between the before- and after-epidemic periods.

Conclusions

These data showed a marked reduction in the number of hospital admissions due to stroke during the COVID-19 epidemic. The change in Ischemic stroke and TIA cases, especially mild cases, was statistically significant.

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  1. ScreenIT

    SciScore for 10.1101/2020.11.17.20233692: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    Our study has several limitations. First, the study population was restricted to cases in hospitals that voluntarily participate in the QIP. The movement of patients to other, non-participating facilities during the COVID-19 epidemic might lead to an overestimate of the impact of the epidemic. However, in the case of hemorrhagic stroke and SAH, the relatively constant trends of hospitalization identified in the study suggest the absence of large-scale movement to other hospitals. It also suggests a lack of significant restrictions on the acceptance of stroke patients by participating hospitals. Second, our DPC data did not include details of the stroke onset time. Consequently, the period of time from symptom onset to hospital arrival was not assessed. Finally, our research included only cases in Japan. Given the differences in healthcare systems and the patterns of the COVID-19 epidemic between countries, it is difficult to judge whether our results can be applied elsewhere. Despite these limitations, our research provides important information on the impact of the COVID-19 epidemic on stroke patients and the facilities caring for them.

    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 10.1101/2020.11.17.20233692v1 on medRxiv