Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era

Background and Purpose: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil. Methods: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019. Results: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 ( P =0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage. Conclusions: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.

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

10.1101/2020.11.17.20233692 ◽

2020 ◽

Author(s):

Hiroyuki Nagano ◽

Daisuke Takada ◽

Jung-ho Shin ◽

Tetsuji Morishita ◽

Susumu Kunisawa ◽

...

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Hemorrhagic Stroke ◽

Hospital Admissions ◽

Health Care Systems ◽

Number Of Patients ◽

Stroke Diagnosis ◽

Before And After ◽

Ischemic Attack ◽

The Impact

AbstractBackground and PurposeThe 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.MethodsWe 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.ResultsA 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.ConclusionsThese 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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Abstract P385: Stroke-Related Hospital Admissions During Covid-19 Pandemic in the Latin American Stroke Registry (LASE)

Stroke ◽

10.1161/str.52.suppl_1.p385 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Virginia Pujol-Lereis ◽

Alan Flores ◽

Antonio Arauz ◽

Carlos Abanto-Argomedo ◽

Pablo Amaya ◽

...

Keyword(s):

Latin American ◽

Hospital Admissions ◽

Stroke Care ◽

Stroke Work ◽

Term Outcome ◽

Stroke Registry ◽

Undetermined Etiology ◽

The Impact ◽

Work Up ◽

Acute Admissions

Background: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially acute admissions and ancillary tests availability. We assessed the impact of the pandemic and the lockdowns imposed in stroke admissions in Latin America. Methods: A multinational study (7 countries, 18 centers) of patients admitted since the pandemic outbreak (January - June 2020). These cases were compared with the same period in 2019. We also assessed patterns during the strictest lockdown period (March-June 2020). Number of cases, stroke etiology and severity, acute care and functional outcomes were compared per periods, months, centers and countries. Results: There were 1863 stroke cases in 2019 and 1781 cases in 2020 (p=0.02). We found a significant increase in strokes of undetermined etiology due to incomplete studies in 2020 [16.8% vs 27.6%, p<0.001]). Most countries reported decreases in all-type stroke admissions, except México and Brasil (16% and 36% increases in admissions, respectively). There were no significant differences among months. All-type mortality increased (6.2% vs. 12.6%, p<0.001), and poor functional outcome (mRs 3-6) increased from 32.2% to 38.8% (p=0.007) in 2020. During the period of strict lockdown (March-June 2020), ischemic stroke admissions during the first 24 hours of onset (68.3% vs. 64.4%, p=0.1) and in-hospital stroke code activation (35.1% vs. 27.6%, p=0.005) diminished compared to 2019 period. No differences in total reperfusion treatment rates were observed, with similar door-to-needle and door-to-groin times in both periods. Conclusions: All-type stroke admissions diminished only slightly during the first months of the COVID-19 pandemic. However, in this region, we found substantial deficiencies in stroke work-up, poor short-term outcome and increased mortality.

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Acute Stroke in Times of the COVID-19 Pandemic

Stroke ◽

10.1161/strokeaha.120.030395 ◽

2020 ◽

Vol 51 (7) ◽

pp. 2224-2227 ◽

Cited By ~ 24

Author(s):

Carolin Hoyer ◽

Anne Ebert ◽

Hagen B. Huttner ◽

Volker Puetz ◽

Bernd Kallmünzer ◽

...

Keyword(s):

Acute Stroke ◽

Transient Ischemic Attack ◽

Hospital Admissions ◽

Social Distancing ◽

Admission Rates ◽

Cerebrovascular Events ◽

Number Of Patients ◽

Before And After ◽

Ischemic Attack ◽

The Impact

Background and Purpose: This study aims to assess the number of patients with acute ischemic cerebrovascular events seeking in-patient medical emergency care since the implementation of social distancing measures in the coronavirus disease 2019 (COVID-19) pandemic. Methods: In this retrospective multicenter study, data on the number of hospital admissions due to acute ischemic stroke or transient ischemic attack and numbers of reperfusion therapies performed in weeks 1 to 15 of 2020 and 2019 were collected in 4 German academic stroke centers. Poisson regression was used to test for a change in admission rates before and after the implementation of extensive social distancing measures in week 12 of 2020. The analysis of anonymized regional mobility data allowed for correlations between changes in public mobility as measured by the number and length of trips taken and hospital admission for stroke/transient ischemic attack. Results: Only little variation of admission rates was observed before and after week 11 in 2019 and between the weeks 1 and 11 of 2019 and 2020. However, reflecting the impact of the COVID-19 pandemic, a significant decrease in the number of admissions for transient ischemic attack was observed (−85%, −46%, −42%) in 3 of 4 centers, while in 2 of 4 centers, stroke admission rates decreased significantly by 40% and 46% after week 12 in 2020. A relevant effect on reperfusion therapies was found for 1 center only (thrombolysis, −60%; thrombectomy, −61%). Positive correlations between number of ischemic events and mobility measures in the corresponding cities were identified for 3 of 4 centers. Conclusions: These data demonstrate and quantify decreasing hospital admissions due to ischemic cerebrovascular events and suggest that this may be a consequence of social distancing measures, in particular because hospital resources for acute stroke care were not limited during this period. Hence, raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated strokes and transient ischemic attacks.

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Diagnostic Accuracy of Transient Ischemic Attack from Physician Claims

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.454 ◽

2017 ◽

Vol 44 (4) ◽

pp. 397-403

Author(s):

Jodi D. Edwards ◽

Mieke Koehoorn ◽

Lara A. Boyd ◽

Boris Sobolev ◽

Adrian R. Levy

Keyword(s):

Diagnostic Accuracy ◽

Transient Ischemic Attack ◽

Hospital Admissions ◽

Population Based ◽

Discharge Data ◽

Predictive Values ◽

Physician Visits ◽

Physician Billing ◽

Ischemic Attack ◽

The Impact

AbstractBackground:Hospitalization data underestimate the occurrence of transient ischemic attack (TIA). As TIA is frequently diagnosed in primary care, methodologies for the accurate ascertainment of a TIA from physician claims data are required for surveillance and health systems planning in this population. The present study evaluated the diagnostic accuracy of multiple algorithms for TIA from a longitudinal population-based physician billing database.Methods:Population-based administrative data from the province of British Columbia were used to identify the base population (1992–2007;N=102,492). Using discharge records for hospital admissions for acute ischemic stroke with a recent (<90 days) TIA as the reference standard, we performed receiver-operating characteristic analyses to calculate sensitivity, specificity, positive and negative predictive values and overall accuracy, and to compare area under the curve for each physician billing algorithm. To evaluate the impact of different case definitions on population-based TIA burden, we also estimated the annual TIA occurrence associated with each algorithm.Results:Physician billing algorithms showed low to moderate sensitivity, with the algorithm for two consecutive physician visits within 90 days showing the highest sensitivity at 37.7% (CI95%=37.4–38.1). All algorithms demonstrated high specificity and moderate to high overall accuracy, resulting in low positive predictive values (≤5%), low discriminability (0.53–0.57) and high false positive rates (1 – specificity). Population-based estimates of TIA occurrence were comparable to prior studies and declined over time.Conclusions:Physician billing data have insufficient sensitivity to identify TIAs but may be used in combination with hospital discharge data to improve the accuracy of estimating the population-based occurrence of TIAs.

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Development of the Madrid Stroke Programme: Milestones and Changes in Stroke Trends and Mortality from 1997 to 2017

Neuroepidemiology ◽

10.1159/000514077 ◽

2021 ◽

pp. 1-6

Author(s):

Silvia Pastor ◽

Elena de Celis ◽

Itsaso Losantos García ◽

María Alonso de Leciñana ◽

Blanca Fuentes ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Admissions ◽

Temporal Trends ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Care Organization ◽

Stroke Units ◽

Health Region ◽

Number Of Patients ◽

The Impact

Introduction: Stroke is a serious health problem, given it is the second leading cause of death and a major cause of disability in the European Union. Our study aimed to assess the impact of stroke care organization measures (such as the development of stroke units, implementation of a regional stroke code, and treatment with intravenous thrombolysis and mechanical thrombectomy) implemented from 1997 to 2017 on hospital admissions due to stroke and mortality attributed to stroke in the Madrid health region. Methods: Epidemiological data were obtained from the National Statistics Institute public website. We collected data on the number of patients discharged with a diagnosis of stroke, in-hospital mortality due to stroke and the number of inhabitants in the Madrid health region each year. We calculated rates of discharges and mortality due to stroke and the number of inhabitants per SU bed, and we analysed temporal trends in in-hospital mortality due to stroke using the Daniels test in 2 separate time periods (before and after 2011). Figures representing annual changes in these data from 1997 to 2017 were elaborated, marking stroke care organizational measures in the year they were implemented to visualize their temporal relation with changes in stroke statistics. Results: Hospital discharges with a diagnosis of stroke have increased from 170.3/100,000 inhabitants in 1997 to 230.23/100,000 inhabitants in 2017. However, the in-hospital mortality rate due to stroke has decreased (from 33.3 to 15.2%). A statistically significant temporal trend towards a decrease in the mortality percentage and rate was found from 1997 to 2011. Conclusions: Our study illustrates how measures such as the development of stroke units, implementation of a regional stroke code and treatment with intravenous thrombolysis coincide in time with a reduction in in-hospital mortality due to stroke.

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Impact of Monovalent Rotavirus Vaccine on Rotavirus Hospitalizations among Children Younger Than 5 Years of Age in the Ouest and Artibonite Departments, Haiti, 2013 to 2019

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0414 ◽

2021 ◽

Author(s):

Anne-Marie Desormeaux ◽

Eleanor Burnett ◽

Gérard Joseph ◽

Mentor Ali Ber Lucien ◽

Negar Aliabadi ◽

...

Keyword(s):

Negative Binomial ◽

Hospital Admissions ◽

Absolute Number ◽

Sensitivity Analyses ◽

Rotavirus Vaccine ◽

Vaccine Introduction ◽

Rotavirus Vaccination ◽

Before And After ◽

Rotavirus Diarrhea ◽

The Impact

Rotavirus is responsible for 26% of diarrheal deaths in Latin America and the Caribbean. Haiti introduced the monovalent rotavirus vaccine in April 2014. The objective of this analysis is to describe the impact of the rotavirus vaccine on hospitalizations among Haitian children younger than 5 years old during the first 5 years after introduction. This analysis includes all children with diarrhea who were enrolled as part of a sentinel surveillance system at two hospitals from May 2013 to April 2019. We compare the proportion of rotavirus-positive specimens in each post-vaccine introduction year to the pre-vaccine period. To account for the potential dilution of the proportion of rotavirus-positive specimens from a waning cholera outbreak, we also analyzed annual trends in the absolute number of positive stools, fit a two-component finite-mixture model to the negative specimens, and fit a negative binomial time series model to the pre-vaccine rotavirus-positive specimens to predict the number of rotavirus diarrhea hospital admissions in the absence of rotavirus vaccination. The overall percentage of rotavirus-positive specimens declined by 22% the first year after introduction, increased by 17% the second year, and declined by 33% to 50% the subsequent 3 years. All sensitivity analyses confirmed an overall decline. We observed a clear annual rotavirus seasonality before and after vaccine introduction, with the greatest activity in December through April, and a biennial pattern, with high sharp peaks and flatter longer periods of increased rotavirus activity in alternating years, consistent with suboptimal vaccination coverage. Overall, our study shows evidence that the introduction of the rotavirus vaccine reduced the burden of severe rotavirus diarrhea.

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Validation of Carotid Artery Revascularization Coding in Ontario Health Administrative Databases

Clinical & Investigative Medicine ◽

10.25011/cim.v39i2.26483 ◽

2016 ◽

Vol 39 (2) ◽

pp. 73 ◽

Cited By ~ 15

Author(s):

Mohamad A Hussain ◽

Muhammad Mamdani ◽

Gustavo Saposnik ◽

Jack V Tu ◽

David Turkel-Parrella ◽

...

Keyword(s):

Carotid Artery ◽

Administrative Data ◽

High Volume ◽

Population Based ◽

Administrative Databases ◽

Ontario Health Insurance Plan ◽

Stroke Registry ◽

Administrative Records ◽

Ischemic Attack ◽

Procedure Codes

Purpose: The positive predictive value (PPV) of carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedure and post-operative complication coding were assessed in Ontario health administrative databases. Methods: Between 1 April 2002 and 31 March 2014, a random sample of 428 patients were identified using Canadian Classification of Health Intervention (CCI) procedure codes and Ontario Health Insurance Plan (OHIP) billing codes from administrative data. A blinded chart review was conducted at two high-volume vascular centers to assess the level of agreement between the administrative records and the corresponding patients’ hospital charts. PPV was calculated with 95% confidence intervals (CIs) to estimate the validity of CEA and CAS coding, utilizing hospital charts as the gold standard. Sensitivity of CEA and CAS coding were also assessed by linking two independent databases of 540 CEA-treated patients (Ontario Stroke Registry) and 140 CAS-treated patients (single-center CAS database) to administrative records. Results: PPV for CEA ranged from 99% to 100% and sensitivity ranged from 81.5% to 89.6% using CCI and OHIP codes. A CCI code with a PPV of 87% (95% CI, 78.8-92.9) and sensitivity of 92.9% (95% CI, 87.4-96.1) in identifying CAS was also identified. PPV for post-admission complication diagnosis coding was 71.4% (95% CI, 53.7-85.4) for stroke/transient ischemic attack, and 82.4% (95% CI, 56.6-96.2) for myocardial infarction. Conclusions: Our analysis demonstrated that the codes used in administrative databases accurately identify CEA and CAS-treated patients. Researchers can confidently use administrative data to conduct population-based studies of CEA and CAS.

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effects of anemia education using web-based she smart to improve knowledge, attitudes, and practice in adolescent girls

International journal of health & medical sciences ◽

10.21744/ijhms.v5n1.1831 ◽

2022 ◽

Vol 5 (1) ◽

pp. 44-49

Author(s):

Ernawati Ernawati ◽

Yusring Sanusi Baso ◽

Healthy Hidayanty ◽

Syafruddin Syarif ◽

Aminuddin Aminuddin ◽

...

Keyword(s):

Adolescent Girls ◽

Statistical Tests ◽

Sampling Technique ◽

P Value ◽

Growth Disorders ◽

Normal Numbers ◽

Web Based ◽

Before And After ◽

Smart Education ◽

The Impact

Anemia is a state of hemoglobin levels in the bloodless than normal numbers according to the sex and age group. The impact of anemia in adolescents is a decrease in achievement and learning spirit and can cause symptoms such as paleness, lethargy, decreased appetite, and growth disorders. Anemia has an impact not only on the health of adolescent girls but can have a long impact on the health of the mother and fetus. You can see the influence of anemia education on knowledge, attitudes, and practice. Uses the Pre-experimental method with the design of one group pretest and posttest. Sampling technique using purposive sampling with the number of 47 adolescent girls. The research was conducted at Senior High School 12 Makassar in September-October 2021. Data analysis using the McNemar test. From the results of statistical tests showed that there was an influence on the use of web-based she smart education model on the use of adolescent girls about anemia with p-value = 0.000 (p<0.05), attitude p-value = 0.016 (p<0.05) and action p-value = 0.001 (p<0.05). Anemia education using web-based she smart can improve knowledge, attitudes, and practice before and after an intervention.

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Abstract P207: Association Between Rehabilitation and Functional Outcomes of Stroke Survivors: A Population-Based Study

Stroke ◽

10.1161/str.52.suppl_1.p207 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Zahra Azizi ◽

Pouria Alipour ◽

Michael Rotondi ◽

Chris I Ardern

Keyword(s):

Functional Outcomes ◽

Survey Design ◽

Healthcare Access ◽

Stroke Care ◽

Canadian Community Health Survey ◽

Population Based ◽

Stroke Survivors ◽

Primary Endpoints ◽

Community Health Survey ◽

The Impact

Background: The increasing rate of stroke and its consequent disabilities has contributed to a growing proportion of stroke survivors requiring rehabilitation. Further research is needed to understand the provision of rehabilitation in the community settings and relationship between variance in stroke care and patient outcomes. Hypothesis: To investigate the association between rehabilitation and functional outcomes of stroke survivors. Method: Data for this analysis was derived from the Canadian Community Health Survey (CCHS) (merged cycles 2013-2016: 237,121 participants). Participants reporting complications from stroke were selected to assess the effect of physiotherapy (PT) and other allied health (AH) utilization. Primary endpoints included need for assistance in activity of daily living (ADL) and injury due to fall in the past 12 months (Inj-Fall). All statistical analyses were performed using R (V.4.0.2) and survey design. Results: Overall, 3,773 (1.1%) patients with stroke (47% females, 71.1% older than 60 years) were studied. Total of 0.2% and 1.6% of stroke survivors in 2013-14 had consulted PT and AH compared to 9.1% and 21% in 2015-16, respectively. Consequently, the rate of need for ADL and Inj-Fall were significantly greater in 2013-14. In general, age was a significant predictor of low accessibility to PT (OR=0.66(0.51-0.85)) or AH (OR=0.79(0.66-0.93)) whereas no significant association between sex and access to PT or AH (P=0.1). As expected, higher income was associated with greater PT utilization (OR=2.11(1.1-4.2)). Finally, PT or AH consultations were significantly associated with less need for assistance in ADL and lower Inj-Fall (Table1). Conclusion: Results of this study reinforce the beneficial effect of rehabilitation on ADL and injury in stroke survivors. Future longitudinal work is necessary to understand directionality of the relationship, and the impact of healthcare access, within varied healthcare systems and models of health .

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Abstract 137: Neighborhood Income and 30-day Readmissions for Stroke and Transient Ischemic Attack

Stroke ◽

10.1161/str.48.suppl_1.137 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Judith H Lichtman ◽

Erica C Leifheit-Limson ◽

Yun Wang ◽

Larry B Goldstein

Keyword(s):

Transient Ischemic Attack ◽

Stroke Care ◽

Stroke Incidence ◽

Logistic Regression Models ◽

Post Stroke ◽

Explanatory Factors ◽

Nationally Representative ◽

Ischemic Attack ◽

The Relationship ◽

Income Quartile

Background: Residence in a socioeconomically challenged neighborhood is associated with increased stroke incidence and shorter post-stroke survival. Little is known about the relationship between socioeconomic status and 30-day post-stroke readmissions. We used a nationally representative readmission database that includes both insured and uninsured patients to determine whether there is a relationship between community-level income and 30-day readmissions after stroke and transient ischemic attack (TIA). Methods: Hospitalizations were identified in the 2013 Nationwide Readmissions Database for patients aged ≥18y with subarachnoid hemorrhage (SAH; ICD-9 430), intracerebral hemorrhage (ICH; ICD-9 431), ischemic stroke (IS; ICD-9 433, 434, 436), and TIA (ICD-9 435). We used mixed logistic regression models with hospital-specific random effects to assess the relationship between community income level (measured according to the median household income quartile for a patient’s ZIP code) and 30-day readmissions. Models were stratified by age and adjusted for demographic and clinical characteristics. Results: There were 7,061 hospitalizations for SAH, 17,325 for ICH, 212,306 for IS, and 67,606 for TIA. In unadjusted analyses, 30-day readmission rates decreased with increasing income quartile for younger patients hospitalized with IS and SAH (figure). In adjusted analyses, this association persisted only among those with IS aged 18-44y for whom each quartile increase in income was associated with a 7% decrease in 30-day readmission (figure). There were no significant associations between income and 30-day readmission for SAH, ICH, and TIA. Conclusions: Overall, community income was not associated with readmission for hemorrhagic stroke and TIA, but higher income was associated with lower 30-day readmission for younger IS patients. Possible explanatory factors such as better access to post-stroke care warrant further research for this subgroup.

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