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Association of the COVID-19 outbreak with acute stroke care in Switzerland

Gian Marco De Marchis, Patrick R Wright, Patrik Michel, Davide Strambo, Emmanuel Carrera, Elisabeth Dirren, Andreas R Luft, Susanne Wegener, Carlo W Cereda, Georg Kägi, Jochen Vehoff, Henrik Gensicke, Philippe Lyrer, Krassen Nedeltchev, Timo Khales, Manuel Bolognese, Stephan Salmen, Rolf Sturzenegger, Christophe Bonvin, Christian Berger, Ludwig Schelosky, Marie-Luise Mono, Biljana Rodic, Andrea Von Reding, Guido Schwegler, Alexander A Tarnutzer, Friedrich Medlin, Andrea M Humm, Nils Peters, Morin Beyeler, Lilian Kriemler, David Bervini, Javier Fandino, Lars G Hemkens, Pasquale Mordasini, Marcel Arnold, Urs Fischer, Leo H Bonati & Swiss Stroke Registry Investigators

abstract

BACKGROUND AND PURPOSE
In Switzerland, the COVID-19 incidence during the first pandemic wave was high. Our aim was to assess the association of the outbreak with acute stroke care in Switzerland in spring 2020.

METHODS
This was a retrospective analysis based on the Swiss Stroke Registry, which includes consecutive patients with acute cerebrovascular events admitted to Swiss Stroke Units and Stroke Centers. A linear model was fitted to the weekly admission from 2018 and 2019 and was used to quantify deviations from the expected weekly admissions from 13 March to 26 April 2020 (the "lockdown period"). Characteristics and 3-month outcome of patients admitted during the lockdown period were compared with patients admitted during the same calendar period of 2018 and 2019.

RESULTS
In all, 28,310 patients admitted between 1 January 2018 and 26 April 2020 were included. Of these, 4491 (15.9%) were admitted in the periods March 13-April 26 of the years 2018-2020. During the lockdown in 2020, the weekly admissions dropped by up to 22% compared to rates expected from 2018 and 2019. During three consecutive weeks, weekly admissions fell below the 5% quantile (likelihood 0.38%). The proportion of intracerebral hemorrhage amongst all registered admissions increased from 7.1% to 9.3% (p = 0.006), and numerically less severe strokes were observed (median National Institutes of Health Stroke Scale from 3 to 2, p = 0.07).

CONCLUSIONS
Admissions and clinical severity of acute cerebrovascular events decreased substantially during the lockdown in Switzerland. Delivery and quality of acute stroke care were maintained.
   
citation De Marchis G M, Wright P R, Michel P, Strambo D, Carrera E, Dirren E, Luft A R, Wegener S, Cereda C W, Kägi G, Vehoff J, Gensicke H, Lyrer P, Nedeltchev K, Khales T, Bolognese M, Salmen S, Sturzenegger R, Bonvin C, Berger C, Schelosky L, Mono M L, Rodic B, Von Reding A, Schwegler G, Tarnutzer A A, Medlin F, Humm A M, Peters N, Beyeler M, Kriemler L, Bervini D, Fandino J, Hemkens L G, Mordasini P, Arnold M, Fischer U, Bonati L H, Swiss Stroke Registry Investigators . Association of the COVID-19 outbreak with acute stroke care in Switzerland. Eur J Neurol 2021;.
   
type journal paper/review (English)
date of publishing 11-12-2021
journal title Eur J Neurol
ISSN electronic 1468-1331
PubMed 34894018
DOI 10.1111/ene.15209