Erdur Hebun, Siegerink Bob, Leithner Christoph, Franke Christiana, Lorenz-Meyer Irina, Theen Sarah, Angermaier Anselm, Kinze Stephan, Weber Joachim E, Rohmann Jessica L, Scheitz Jan F, Nolte Christian H, Endres Matthias, Audebert Heinrich J
Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Front Neurol. 2021 Jan 6;11:607193. doi: 10.3389/fneur.2020.607193. eCollection 2020.
Many regions worldwide reported a decline of stroke admissions during the early phase of the coronavirus disease 2019 (COVID-19) pandemic. It remains unclear whether urban and rural regions experienced similar declines and whether deviations from historical admission numbers were more pronounced among specific age, stroke severity or treatment groups. We used registry datasets from (a) nine acute stroke hospitals in Berlin, and (b) nine hospitals from a rural TeleNeurology network in Northeastern Germany for primary analysis of 3-week-rolling average of stroke/TIA admissions before and during the COVID-19 pandemic. We compared course of stroke admission numbers with regional cumulative severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) infections. In secondary analyses, we used emergency department logs of the Berlin Charité University hospital to investigate changes in age, stroke severity, and thrombolysis/thrombectomy frequencies during the early regional Sars-CoV-2 spread (March and April 2020) and compared them with preceding years. Compared to past years, stroke admissions decreased by 20% in urban and 20-25% in rural hospitals. Deviations from historical averages were observable starting in early March and peaked when numbers of regional Sars-CoV-2 infections were still low. At the same time, average admission stroke severity and proportions of moderate/severe strokes (NIHSS >5) were 20 and 20-40% higher, respectively. There were no relevant deviations observed in proportions of younger patients (<65 years), proportions of patients with thrombolysis, or number of thrombectomy procedures. Stroke admissions at Charité subsequently rebounded and reached near-normal levels after 4 weeks when the number of new Sars-CoV-2 infections started to decrease. During the early pandemic, deviations of stroke-related admissions from historical averages were observed in both urban and rural regions of Northeastern Germany and appear to have been mainly driven by avoidance of admissions of mildly affected stroke patients.
全球许多地区报告称，在2019冠状病毒病（COVID-19）大流行的早期阶段，中风入院人数有所下降。目前尚不清楚城乡地区的下降情况是否相似，以及特定年龄、中风严重程度或治疗组与历史入院人数的偏差是否更为明显。我们使用了（a）柏林九家急性中风医院和（b）德国东北部农村远程神经学网络的九家医院的登记数据集，对COVID-19大流行之前和期间中风/短暂性脑缺血发作（TIA）入院人数的3周滚动平均值进行了初步分析。我们将中风入院人数的变化过程与区域严重急性呼吸综合征冠状病毒2（Sars-CoV-2）感染的累积情况进行了比较。在二次分析中，我们使用了柏林夏里特大学医院急诊科的日志，调查了在区域Sars-CoV-2早期传播期间（2020年3月和4月）年龄、中风严重程度以及溶栓/血栓切除术频率的变化，并将其与前几年进行了比较。与过去几年相比，城市医院的中风入院人数下降了20%，农村医院下降了20%-25%。从3月初开始可以观察到与历史平均值的偏差，并且在区域Sars-CoV-2感染人数仍然较低时达到峰值。与此同时，平均入院中风严重程度以及中度/重度中风（美国国立卫生研究院卒中量表[NIHSS]>5）的比例分别高出20%和20%-40%。在年轻患者（<65岁）的比例、接受溶栓治疗的患者比例或血栓切除术的数量方面未观察到相关偏差。夏里特医院的中风入院人数随后出现反弹，在新的Sars-CoV-2感染人数开始下降4周后达到接近正常的水平。在大流行早期，德国东北部的城乡地区均观察到与中风相关的入院人数与历史平均值存在偏差，这似乎主要是由于轻度中风患者避免入院所致。
