Impact of COVID-19 on hospital admission of acute stroke patients in Bangladesh
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Abstract
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. This paper investigated this presumption by comparing the frequency of admissions of stroke cases in Bangladesh before and during the pandemic.
Methods
This is 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. All the admitted cases from 1 January to 30 June 2020 were considered. Poisson regression models were used to determine whether statistically significant changes in admission rates 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 took admission in the stroke unit during the study period. Half of the patients were older than 60 years, whereas only 2.6% were 30 years old or younger. The male to female ratio is 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 SARS Cov-2 positive based on nasal swab testing.
Conclusion
This study revealed a more than fifty percent reduction in acute stroke admission during the COVID-19 pandemic. Whether the reduction is related to the fear of getting infected by COVID-19 from hospitalization or the overall restriction on public movement or stay-home measures remains unknown.
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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 Statement IACUC: 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.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable Male 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 Sentences Resources Data analysis was done by … 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 Statement IACUC: 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.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable Male 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 Sentences Resources Data analysis was done by Statistical Package for Social Sciences (SPSS) version 21 and R version 4.0.0. SPSSsuggested: (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.
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