COVID-19 Impact on Stroke Admissions during France’s First Epidemic Peak: An Exhaustive, Nationwide, Observational Study

  1. Clémence Risser
  2. Pierre Tran Ba Loc
  3. Florence Binder-Foucard
  4. Thibaut Fabacher
  5. Hassina Lefèvre
  6. Claire Sauvage
  7. Erik-André Sauleau
  8. Valérie Wolff

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

<b><i>Introduction:</i></b> The coronavirus disease 2019 (COVID-19) pandemic continues to have great impacts on the care of non-COVID-19 patients. This was especially true during the first epidemic peak in France, which coincided with the national lockdown. The aim of this study was to identify whether a decrease in stroke admissions occurred in spring 2020, by analyzing the evolution of all stroke admissions in France from January 2019 to June 2020. <b><i>Methods:</i></b> We conducted a nationwide cohort study using the French national database of hospital admissions (Information Systems Medicalization Program) to extract exhaustive data on all hospitalizations in France with at least one stroke diagnosis between January 1, 2019, and June 30, 2020. The primary endpoint was the difference in the slope gradients of stroke hospitalizations between pre-epidemic, epidemic peak, and post-epidemic peak phases. Modeling was carried out using Bayesian techniques. <b><i>Results:</i></b> Stroke hospitalizations dropped from March 10, 2020 (slope gradient: −11.70), and began to rise again from March 22 (slope gradient: 2.090) to May 7. In total, there were 23,873 stroke admissions during the period March–April 2020, compared to 29,263 at the same period in 2019, representing a decrease of 18.42%. The percentage change was −15.63%, −25.19%, −18.62% for ischemic strokes, transient ischemic attacks, and hemorrhagic strokes, respectively. <b><i>Discussion/Conclusion:</i></b> Stroke hospitalizations in France experienced a decline during the first lockdown period, which cannot be explained by a sudden change in stroke incidence. This decline is therefore likely to be a direct, or indirect, result of the COVID-19 pandemic.

Article activity feed

  1. Version published to 10.1159/000523685
  2. ScreenIT

    SciScore for 10.1101/2021.08.03.21261438: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: The Strasbourg University Hospital Ethics Committee has approved this study (reference: CE-2021-14).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot 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:
    A limitation of using the PMSI national database is that a possible delay can occur between patient discharge and coding. However, the extent of this bias is limited, as the hospital is reimbursed by the state health insurance only if diagnoses made during hospitalization are sent to the national database no more than one month after discharge. To ensure that data is as complete as possible, the analysis period was ended on 30 June 2020, i.e., leaving more than three months for patient codes to be registered before the date of extraction from the database in October 2020. Homogeneity of the diagnostic coding, which must be as close as possible to those noted during the stay, is provided by strict, national rules with regular checks carried out by the payer, thus limiting misclassification bias. A final limitation of our study is restricted knowledge of other external local events which could influence the activity of the hospital facility. Such biases are nevertheless partially controlled by the study design, as analysis is carried out at a national level, and the annual time periods compared time periods compared are proximal. Within this study, we have not extended the analysis across a sufficient number of previous years to be able to determine whether there is a seasonal effect on stroke admissions. In previous unpublished analyses, carried out for internal purposes using data from Strasbourg University Hospital, we were able to identify a decrease in the trend of hospita...

    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.

    Results from scite Reference Check: We found no unreliable references.

    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.

  3. Version published to 10.1101/2021.08.03.21261438v1 on medRxiv