Impact of Treatment and Anticoagulation on Thrombosis in COVID-19 Patients

Background The Coronavirus disease-2019 (COVID-19) is a global pandemic. Acute respiratory compromise and systemic coagulopathy cause significant morbidity and mortality. Venous thromboembolism (VTE), which encompasses both deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as arterial thromboembolism (ATE), which includes stroke, are common sequelae described in this patient population. COVID-19 coagulopathy is attributed to severe inflammation and endothelial dysfunction resulting in a prothrombotic state. COVID-19 related treatment has focused on targeting the unregulated inflammatory state in an attempt to decrease incidence of COVID-19 related complications, such as thrombosis. Prophylactic anticoagulation is recommended, and many suggest intermediate to therapeutic anticoagulation in severe COVID-19. However, there is no clear data showing impact of anticoagulation on morbidity and mortality in patients with COVID-19. Methods A retrospective analysis was performed on all COVID-19 patients hospitalized between March 2020 and June 2020 at our institution. Patient charts were individually reviewed to ensure accuracy of data. Thromboembolic events (VTE or ATE) verified by imaging were included in the analysis. The impact of COVID-19 specific treatments such as Remdesivir, Tocilizumab, Hydroxychloroquine, and steroids on incidence of thrombosis was analyzed by using X2 testing. Using logistics regression, we analyzed the effect of prophylactic versus therapeutic anticoagulation received before development of thrombosis on mortality. Results Out of 1265 COVID-19 positive hospitalized patients during our time frame, 138 (10.9%) had thromboembolism. Incidence of 6.3% VTE, 5.6% DVT, 4.8% PE in COVID-19 patients was significantly higher than 0.24% VTE, 0.15% DVT, 0.12% PE in non COVID-19 hospitalized patients as reported by CDC (p<.0001 for all). Amongst patients with COVID-19, mortality for patients with thrombosis is significantly higher than patients without thrombosis (31.9% vs. 10%, p<0.001). Hispanic patients had a significantly higher mortality rate of 51% compared to African American 18%, other 29%, or Caucasian 20% (p=0.0020). Patients with PE had a significantly higher mortality rate than patients with non-pulmonary thrombotic events (18.0% vs. 13.7%, p=0.0412).The incidence of thrombosis was significantly less in those who received steroids at 14% as compared to other COVID-19 treatment: Tocilizumab 25% (p=0.0031), Hydroxychloroquine 42% (p<.0001), and Remdesivir 72% (p<.0001). Adjusting for gender, age, race, BMI, the mortality rate in COVID-19 patients with thrombosis was higher in patients who had COVID-19 related treatment compared to without treatment: Remdesivir OR (4.67, 95% CI 1.43- 15.2), steroids OR (4.52, 95% CI 1.82- 11.18), Tocilizumab OR (2.51, 95% CI 1.06-5.96), and Hydroxychloroquine OR (1.54, 95% CI .661- 3.59). There was no difference in mortality in patients who had prophylactic enoxaparin 40.5% compared to therapeutic enoxaparin 51.7% (p= 0.3491) (Figure 1). Adjusting for all demographics, a logistics model showed βprophylaxis anticoagulation= βTherapeutic anticoagulation showing no mortality difference in patients who had either dosing of anticoagulation (difference=0.2658, Z=.55, p=0.5810). Conclusion In Our study the incidence of thrombosis in hospitalized COVID-19 patients was significantly higher than non-COVID-19 hospitalized patients. COVID-19 patients with thrombosis had higher mortality compared to COVID-19 patient without thrombosis, particularly patients with PE. Hispanic patients with COVID-19 and thrombosis experienced a higher mortality rate compared to non-Hispanic patients. The lowest incidence of thrombosis occurred in COVID-19 patients who received steroids, followed by Tocilizumab suggesting that steroids and Tocilizumab may reduce the pro-inflammatory state leading to thrombosis. However, mortality rate was higher in patients who received COVID-19 related treatment, suggesting that these patients likely had severe disease. There was no mortality difference in patients who received prophylactic versus therapeutic anticoagulation prior to thrombosis. Randomized control trials will address the impact of anticoagulation dosing on morbidity and mortality in COVID-19 patients and study the post discharge prophylaxis and long-term outcomes in these patients. Disclosures No relevant conflicts of interest to declare.

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Dissemination of extreme levels of extracellular vesicles: tissue factor activity in patients with severe COVID-19

Blood Advances ◽

10.1182/bloodadvances.2020003308 ◽

2021 ◽

Vol 5 (3) ◽

pp. 628-634

Author(s):

Christophe Guervilly ◽

Amandine Bonifay ◽

Stephane Burtey ◽

Florence Sabatier ◽

Raphaël Cauchois ◽

...

Keyword(s):

Septic Shock ◽

Tissue Factor ◽

Extracellular Vesicles ◽

Severe Disease ◽

Plasminogen Activator Inhibitor ◽

Hospitalized Patients ◽

Plasminogen Activator Inhibitor 1 ◽

Thrombotic Risk ◽

Public Health Challenges ◽

Inflammatory State

Abstract Coronavirus disease 2019 (COVID-19) has become one of the biggest public health challenges of this century. Severe forms of the disease are associated with a thrombo-inflammatory state that can turn into thrombosis. Because tissue factor (TF) conveyed by extracellular vesicles (EVs) has been implicated in thrombosis, we quantified the EV-TF activity in a cohort of hospitalized patients with COVID-19 (n = 111) and evaluated its link with inflammation, disease severity, and thrombotic events. Patients with severe disease were compared with those who had moderate disease and with patients who had septic shock not related to COVID-19 (n = 218). The EV-TF activity was notably increased in patients with severe COVID-19 compared with that observed in patients with moderate COVID-19 (median, 231 [25th to 75th percentile, 39-761] vs median, 25 [25th to 75th percentile, 12-59] fM; P < .0001); EV-TF was correlated with leukocytes, D-dimer, and inflammation parameters. High EV-TF values were associated with an increased thrombotic risk in multivariable models. Compared with patients who had septic shock, those with COVID-19 were characterized by a distinct coagulopathy profile with significantly higher EV-TF and EV-fibrinolytic activities that were not counterbalanced by an increase in plasminogen activator inhibitor-1 (PAI-1). Thus, this article is the first to describe the dissemination of extreme levels of EV-TF in patients with severe COVID-19, which supports the international recommendations of systematic preventive anticoagulation in hospitalized patients and potential intensification of anticoagulation in patients with severe disease.

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Ethnicity Significantly Influences Incidence Patterns and Predicts Mortality: Adult Hodgkin Lymphoma (HL) In the United States (US)

Blood ◽

10.1182/blood.v116.21.2683.2683 ◽

2010 ◽

Vol 116 (21) ◽

pp. 2683-2683

Author(s):

Andrew M Evens ◽

Eileen Shiuan ◽

Soyang Kwon ◽

Leo I Gordon ◽

Brian Chiu

Keyword(s):

Mortality Rate ◽

Conflicts Of Interest ◽

The United States ◽

Annual Percent Change ◽

Black Females ◽

The Past ◽

Seer Data ◽

Black Populations ◽

And Gender ◽

The Impact

Abstract Abstract 2683 Background: Pediatric HL studies have suggested survival differences based on ethnicity. However, little data is available regarding the impact, if any, of ethnicity on incidence patterns, disease histology, and/or survival among adult HL. Methods: We examined data for 13 US SEER areas, several of which contain large Hispanic and Black populations. Case information was obtained from the 11/2009 SEER data submission released April 2010. We analyzed incidence, HL histology, and mortality rates according to ethnicity, age, and gender. We also examined incidence patterns across the past four decades. All analyses used SEER*Stat. Results: A total of 16,783 HL cases were diagnosed among residents in the 13 SEER registry areas during 1992–2007, with non-Hispanic Whites contributing the largest number (n=11,890), followed by Hispanics (n=2,190), and Blacks (n=1,724). Consistent with SEER 9 results (1973 data), Whites show a continued bimodal age-incidence curve (6.0/100,000 ages 25–29, 2.5/100,000 ages 50–54, and 4.5/100,000 age 75–79). However, Blacks have a much less apparent bimodal pattern (4.5/100,000 ages 25–29, 2.6/100,000 ages 50–54, and 3.0/100,000 ages 75–79), while Hispanics are distinctly not bimodal with a small increase at 20–24 (2.4/100,000) followed by an exponential-like increase with peak HL incidence at ages 80–84 (7.0/100,000). Moreover, among persons >65 years, HL is currently significantly more common in Hispanics than Whites (4.7-7.0/100,000 vs 3.9–4.5/100,000, respectively, p<0.05). With gender, HL is more common in males than females, regardless of ethnicity. Interestingly, the male excess, however, does not occur until ages 30–34 (all ethnicities). Furthermore, from 1975–2007, HL incidence increased in Black females (annual percent change (APC) = 2.5; p<0.05) and White females (APC = 0.4; p<0.05). According to histology, both nodular sclerosis and mixed cellularity are more common in Whites followed by Blacks and Hispanics, while in persons age 60–84, both histologies are significantly more common in Hispanics compared with Whites and Blacks. Over the past 20 years, mortality has declined within each race by 10.3%–13.7% (p<0.05). However, age-specific ethnic survival disparities are apparent (Figure 1). For ages 65–84, Hispanics have a significantly increased mortality rate compared with Whites/Blacks (p<0.05). Conversely, among ages 20–44, Hispanics have a lower mortality rate versus Whites and Blacks. Conclusions: Multiple important epidemiologic and mortality differences are evident across and within ethnicities in adult HL. *Both sexes (1992-2007). Rates are per 100,000. Mortality source: US Mortality Files, National Center for Health Statistics, CDC. Accessed August 12th, 2010. Disclosures: No relevant conflicts of interest to declare.

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199 Impact of Frailty on Complications in Patients with Thoracic and Thoracolumbar Spinal Trauma

Neurosurgery ◽

10.1093/neuros/nyx417.199 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 253-254

Author(s):

Remi Aria Kessler ◽

Taylor Elise Purvis ◽

Rafael De la Garza Ramos ◽

Ali Karim Ahmed ◽

C Rory Goodwin ◽

...

Keyword(s):

Mortality Rate ◽

Surgical Intervention ◽

Adult Spinal Deformity ◽

Frailty Index ◽

Neck Surgery ◽

Thoracolumbar Fracture ◽

Morbidity And Mortality ◽

Frailty Status ◽

Frail Patients ◽

The Impact

Abstract INTRODUCTION It is well-documented that geriatric patients are at risk for serious injuries after trauma due to pre-existing medical conditions, physical changes of aging, and medication effects. Frailty has been demonstrated to be a predictor of morbidity and mortality in inpatient head and neck surgery, and for surgical intervention for adult spinal deformity and degenerative spine disease. However, the impact of frailty on complications following traumatic thoracolumbar/thoracic fracture is unknown and has not been previously assessed in the literature, particularly in a nationwide setting. METHODS This was a retrospective study of the prospectively-collected American College of Surgeons National Surgical Quality Improvement database for the years 2007 through 2012. Patients who underwent spinal decompression (+/− fusion) or an alternative intervention, defined as vertebroplasty or kyphoplasty (VP/KP) for thoracic or thoracolumbar fracture were identified. Frailty status was determined using a modified frailty index from the Canadian Study of Health and Aging Frailty Index, with frailty defined as a score = 0.27. 30-day morbidity and mortality were compared between frail and non-frail patients in each treatment group. RESULTS >A total of 303 patients were included in this study. Of these, 38% of patients had VP/KP and 62% underwent surgery. Within the VP/KP cohort, 26% were frail. The proportion of these patients who developed at least one complication was 3.3% versus 3.6% for non-frail patients (P = 1.0). The 30-day mortality for frail versus not frail patients in this cohort was 0% versus 2.4% (P = 1.0) Among the surgical group, 13% were frail. In contrast, the likelihood of complications was 33.3% among frail patients and 4.2% for non-frail patients (P = <0.001). Frail patients also had a 16.7% 30-day mortality rate as compared to 0.6% in the non-frail group (P = 0.001). CONCLUSION Frailty and traditional surgical intervention are correlated with a higher 30-day complication and mortality rate in patients with traumatic thoracic and thoracolumbar fracture.

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Antigen Density Impacts RBC Survival and Antigen Modulation Following Incompatible RBC Transfusion

Blood ◽

10.1182/blood.v126.23.2350.2350 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2350-2350

Author(s):

Justin Yoo ◽

Connie Maridith Arthur ◽

Patricia Zerra ◽

Kathryn Girard-Pierce ◽

Jeanne E. Hendrickson ◽

...

Keyword(s):

Conflicts Of Interest ◽

Flow Cytometric Analysis ◽

Antigen Expression ◽

Morbidity And Mortality ◽

Transfusion Therapy ◽

Flow Cytometric ◽

Glycoprotein Antigen ◽

Compatible Blood ◽

The Impact ◽

Rbc Transfusion

Abstract Background: While chronic transfusion therapy can signficantly reduce morbidity and mortality in patients with hemoglonbinopathies, transfusion is not without risk. Differences in red blood cell (RBC) antigen distributions between donors and recipients can result in the development of RBC alloantibodies, which can make it difficult, if not impossible, to find compatible blood. As a result, heavily alloimmunized individuals experience greater morbidity and mortality than those who do not possess RBC-induced alloantibodies. While incompatible RBC transfusion can result in fatal hemolytic transfusion reactions (HTRs), these adverse events are not the invariable outcome of incompatible transfusion. Although a variety of factors likely contribute to the likilihood of developing a HTR following incompatible RBC transfusion, variability in the density of the donor antigen may contribute to different outcomes. Using a novel model that utilizes RBC donors with different levels of the KEL antigen, we sought to directly examine the impact of antigen density on RBC clearance following incompatible RBC transfusion. Methods: Wild type C57BL/6 mice (WT) were passively immunized with anti-KEL serum, generated following immunization of WT recipients with KEL RBCS, 2 hours prior to incompatible KEL RBC transfusion. RBC collected from previously generated KEL transgenic mice that express high (KELhi), intermediate (KELmed), and low (KELlo) levels of human KEL glycoprotein antigen, were labeled with chloromethylbenzamido 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI), while WT RBC were labeled with fluorescently distinct 3,3'-dihexadecyloxacarbocyanine perchlorate (DiO) to facilitate detection post-transfusion. Passively immunized recipient WT mice were transfused with labeled KEL RBC to WT RBC. Percent KEL RBC survival was measured using flow cytometric analysis at various time points post transfusion by comparing the DiI to DiO ratio. Bound antibody, complement and the KEL antigen were assessed by staining cells with anti-Ig, anti-C3 and anti-KEL followed by flow cytometric analysis. Results: Transfusion of RBCs expressing low, intermediate or high levels of the KEL antigen into non-immunized mice failed to result in any detectable alteration in RBC survival or KEL expression. However, transfusion of KELlo, KELmed and KELhi RBCs into anti-KEL immunized recipients resulted in differential clearance of each population, with KELhi experiencing the most clearance, followed by KELmed and KELlo. Similarly, the level of detectable C3 and bound antibody on KEL positive cells likewise correlated with the initial level of KEL antigen expression, with more C3 and IgG being detected on the surface of KELhi following transfusion into immunized recipients, than KELmed or KELlo. However, KELhi RBCs also experience the most significant alterations in KEL antigen levels following antibody engagement. Regardless of the KEL positive RBC transfused, each population developed a relatively rapid state of resistance to additional anti-KEL-mediated RBC removal. Conclusions: Our results indicate that lower antigen densities may be less efficient in not only facilitating rapid clearance of RBCs following incompatible transfusion, but also antibody-induced antigen modulation. While KELhi RBCs displayed the greatest degree of clearance and antigen modulation, each population developed resistance to antibody-mediate removal, suggesting that once RBC antigen levels fall below a certain threshold, clearance discontinues, regardless of the initial levels of antigen prior to incompatible transfusion. Taken together, these results suggest that antigen density may provide an additional feature of RBC transfusion that may impact the outcome of incompatible transfusion in heavily alloimmunized recipients. Disclosures No relevant conflicts of interest to declare.

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Impact of a National Lockdown for COVID-19 on Morbidity and Mortality Among Children with Sickle Cell Anaemia at a Tertiary Care Hospital in Uganda

Blood ◽

10.1182/blood-2020-142417 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 33-34

Author(s):

Ruth Namazzi ◽

Robert Opoka ◽

Andrea L Conroy ◽

Dibyadyuti Datta ◽

Micheal Goings ◽

...

Keyword(s):

Sickle Cell ◽

Sickle Cell Anaemia ◽

Conflicts Of Interest ◽

Tertiary Care ◽

School Closure ◽

Morbidity And Mortality ◽

Care Hospital ◽

Phone Calls ◽

The Impact

COVID-19 and its prevention has put considerable strain on health care systems in low and middle-income countries (LMIC). In Uganda, a national lockdown was declared on March 18, 2020, in response to COVID-19 pandemic and concern of spread of cases without aggressive measures to prevent spread. The lockdown consisted of closure of all offices except essential ones, orders to stay at home unless an emergency occurred, school closure, a ban on all meetings of more than 10 people, a ban on public and private transport, closing down of all shops, malls, restaurants, places of worship and other facilities in which group meetings might occur, keeping a distance of at least 2 metres from other people in public places and a 7:00 p.m. to 6:30 a.m. curfew. Hospitals however remained open and operational. We describe the impact of the lockdown in Uganda in response to the COVID-19 pandemic on the morbidity and mortality in children with sickle cell anaemia (SCA) at a tertiary hospital in Uganda. The number of clinic visits for SCA related complications and death were compared in the pre-lockdown (November 2019 to February 2020) and during COVID-19 lockdown periods (March 2020 to June 2020) in children aged 1- 4.99 years enrolled in a SCA research study [Zinc for Infection Prevention in Sickle cell anaemia (NCT03528434)] at Jinja Hospital, Uganda. In the study, children with SCA are asked to return to the hospital for evaluation whenever they are unwell. Follow up phone calls are made to ascertain the wellbeing of the children and identify any who are unable to come to the hospital. During the lockdown, follow up calls continued and facilitation was provided for caregivers to bring any child who was unwell to the hospital for evaluation. A total of 238 children with a mean (standard deviation) age of 2.7(1.1) years were enrolled and were being followed up when the pandemic started. The incidence of hospital sick visits pre-lockdown and during the lockdown period was 7.7 vs 4.0 person-year, (p= <0.0001). Incidence of hospitalization, pain crises, severe anaemia, or malaria were all higher in the pre-lockdown period than during the lockdown period, 2.4 vs.1.0, 1.8 vs. 0.7, 0.7 vs. 0.4, 0.6 vs. 0.2 and per person year respectively (all p values < 0.01). There were no deaths during the lockdown period compared to 1 death in the pre-lockdown period. Less than 1000 cases of COVID-19 were reported nationally in this period, and none of the study children had known COVID-19 infection, though testing capacity for this was limited. In this cohort of children with SCA, hospitalization and morbidity from SCA-related complications and malaria were are significantly lower during a lockdown period for COVID-19 pandemic than before the lockdown. Reduced access to hospital care is unlikely to explain these findings, as sick children still received care at the hospital, and there was no increase in mortality. Reduced interaction with peers because of the lockdown and social distancing, leading to fewer infections that may trigger SCA-complications, may explain the reduced incidence of SCA complications in this population during the COVID-19 lockdown period in Uganda. Disclosures No relevant conflicts of interest to declare.

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PERFORMANCE OF THE NURSE IN FRONT OF THE USER VICTIM OF TRAUMA CAUSED BY FIREARMS PROJECTILES: AN EXPERIENCE REPORT

Health and Society ◽

10.51249/hes01.01.2021.169 ◽

2021 ◽

Keyword(s):

Mortality Rate ◽

High Mortality ◽

Experience Report ◽

Morbidity And Mortality ◽

Nursing Process ◽

Qualitative And Quantitative ◽

Type Study ◽

New Research ◽

The Impact ◽

Nursing Course

Firearm trauma is considered one of the main reasons for morbidity and mortality in Brazil. In view of its destructive capacity of organs and tissues that come into contact with the fragments of the bullet. This work aims to report the experience of three students of the nursing course, facing the care of a patient with a firearm. This is a descriptive, qualitative, experience report type study. In the present study, it was possible to envision the application of the nursing process in its entirety, which allowed us to think of a plan based on the process of rehabilitation and healing of the patient. Going up a discussion about the violence in the country, since it is taking a high mortality rate between 15 to 24 years. Based on the construction of this work, it is suggested to create new research that addresses in a qualitative and quantitative way the impact of cases of violence in today's society.

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Abstract 15745: Health Outcomes in Pulmonary Arterial Hypertension Patients With COVID-19: A Real-world Analysis

Circulation ◽

10.1161/circ.142.suppl_3.15745 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

jeremy feldman ◽

melisa wilson ◽

Alexander Kantorovich ◽

Alexander DeRuiter ◽

Kevin Schreur ◽

...

Keyword(s):

Real World ◽

Chronic Conditions ◽

Severe Disease ◽

Hospitalized Patients ◽

Categorical Variables ◽

Healthcare Organizations ◽

All Cause Mortality ◽

Pulmonary Arterial ◽

Matched Data ◽

The Impact

Introduction: Patients with underlying chronic conditions, including PAH, are predicted to have worse outcomes with COVID-19. This analysis aimed to assess the impact of COVID-19 on outcomes in PAH patients. Methods: Over a 5-month period starting 1/1/2020, PAH patients with COVID-19 were compared to PAH patients without COVID-19. In addition, COVID-19 patients with and without PAH were analyzed. Differences in all-cause mortality, all-cause hospitalization, and need for mechanical ventilation (MV) at any time after COVID-19 diagnosis were evaluated. Similar analyses were performed between subgroups of hospitalized patients. PAH and COVID-19 patients were identified by ICD and CPT codes along with PAH-specific medications from the TriNetX Dataworks Network of 35 international healthcare organizations. Cohorts were compared using unmatched and propensity-matched data (PMH, demographics, labs, and non-PAH medications) with categorical variables evaluated using χ 2 /Fisher’s Exact tests. Results: A total cohort of 566 patients were identified with a diagnosis of PAH; 510 without COVID-19 and 56 with COVID-19. In PAH patients with COVID-19, there were significantly higher rates of all-cause mortality, all-cause hospitalization, and need for MV (p<0.00001) compared to PAH patients without COVID-19. Mortality in the PAH with COVID-19 cohort was 16% compared to 2% in the PAH group without COVID-19. After matching, significance was maintained in all-cause hospitalization (P=0.0013) and need for MV (P=0.0009). Adjusting for disease severity examining only matched all-cause hospitalized patients, death and need for MV was significantly higher in the PAH patients with COVID-19. When comparing PAH patients with COVID-19 versus a matched COVID-19 cohort without PAH, there were no differences in any evaluated outcomes. Conclusions: This real-world analysis demonstrates that PAH patients with COVID-19 have worse outcomes, including a higher rate of all-cause mortality at 5 months, compared to PAH patients without COVID-19. Additionally, no differences were observed between COVID-19 patients with or without PAH. In a subset of patients with more severe disease that were hospitalized, the results were consistent to those from the overall cohort.

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THE IMPACT OF NON-INVASIVE VENTILATION TO READMISSION AND SHORT-TERM MORTALITY RATE IN HOSPITALIZED PATIENTS WITH PNEUMONIA COMING FROM COMMUNITY

CHEST Journal ◽

10.1016/j.chest.2020.05.067 ◽

2020 ◽

Vol 157 (6) ◽

pp. A58

Author(s):

A. Sadigov ◽

A. Agayeva ◽

S. Akhundov

Keyword(s):

Mortality Rate ◽

Hospitalized Patients ◽

Invasive Ventilation ◽

Short Term ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Short Term Mortality ◽

The Impact

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The Impact of Patient’s Fear of COVID-19 Infection on Neurology Service in University Hospital Center Sestre Milosrdnice During COVID-19 Epidemic Outbreak

Archives of Psychiatry Research ◽

10.20471/dec.2021.57.02.05 ◽

2021 ◽

Vol 57 (2) ◽

pp. 169-178

Author(s):

Arijana Lovrenčić-Huzjan ◽

Marina Roje-Bedeković ◽

Neurology Collaboration Group

Keyword(s):

Emergency Department ◽

Mortality Rate ◽

Disease Severity ◽

Morbidity And Mortality ◽

University Hospital ◽

Neurologic Disease ◽

Stroke Treatment ◽

Ventilation Time ◽

Time Period ◽

The Impact

Increasing evidence suggests that patients with medical emergencies are avoiding the emergency department because of fear of coronavirus disease 2019 (COVID-19) infection, leading to increased morbidity and mortality due to other diseases. In order to analyse the impact of patient’s fear of COVID-19 on the admittance rate of stroke patients and severity of neurological diseases, we compared the stroke admittance rate, numbers of thrombectomies and thrombolysis and hospitalization refusal rate during the time period from March 1st until June 30th 2020 in temporal relationship with the rising numbers of COVID-19 cases in Croatia. We assessed the patients’ neurologic disease severity measured by ventilation time and mortality rate in the same time period. We compared the data with the data obtained from the same time period in 2019. We observed dramatically decreased presentation in Neurologic Emergency Department due to stroke and neurologic disease in 2020 compared to 2019, increased refused hospitalization rate and similar stroke treatment rate despite bigger catchment area. Greater neurologic disease severity with almost 40% increased ventilation time and double mortality rate during the same time was observed. During the outbreak of COVID-19 epidemic, fear of infection had significant impact on neurologic service leading to decreased presentation to NED, resulting in increased stroke or neurologic disease-related morbidity and mortality.

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