gms | German Medical Science

Objective: During the COVID-19 pandemic, a decrease in hospital admissions of acute ischemic stroke (AIS) was observed globally. On a national scale, no data specific to Germany have emerged on this issue so far. This investigation was designed to detect possible changes in mortality and clinical management of AIS before and during the pandemic with special emphasis on neurosurgical and endovascular interventions.

Methods: Using administrative data from a nationwide network of 67 hospitals we identified patients with AIS associated with atrial fibrillation by respective codes according to the International Statistical Classification of Diseases (ICD). The time period with the highest load of hospitalized COVID-19 cases between March 26 and May 13, 2020 was defined as “peak phase” followed by a “recovery phase” up until Sept. 22, 2020. We compared therapeutic interventions in both phases to corresponding time periods in 2019 (“prepandemic phases”). The following categories of AIS management were examined: thrombolysis (TL), thrombectomy (TE), decompressive hemicraniectomy (DHC), mechanical ventilation (MV) and intensive care (ICU).

Results: A total of 3.752 AIS cases were included. During the peak phase in 2020, AIS hospitalizations decreased by 23% compared to 2019 (607 vs. 467; p<0.01). In contrast, during the COVID-19 recovery phase AIS hospitalizations did not differ from 2019 (1.388 vs. 1.290; p=0.06). The distribution of AIS management types during the peak period in 2020 did not differ significantly from 2019: TL: 12% vs. 13%; TE: 9% vs. 11%; DHC: 1% vs. 1%; MV 6% vs. 6%; ICU: 73% vs. 79%; respective p-values >0.05). In contrast, during the recovery phase in 2020, we observed slight increases in the proportions of cases receiving TE (14% vs. 10%; p=0.01) and ICU (81% vs. 73%; p<0.01) when compared to 2019 while the proportion of the other management types remained unchanged (TL: 13% vs. 14%; DHC: 1% vs. 1%; MV: 7% vs. 7%; respective p-values >0.05). In-hospital mortality of AIS was 13% during the peak phase (vs. 10% in 2019 [p=0.08]), and 10% during the recovery phase (vs. 10% in 2019 [p=0.93]).

Conclusion: Even though the amount of AIS cases hospitalized in Germany decreased substantially during the COVID-19 peak phase, in-hospital mortality and treatment strategies remained the same as before the pandemic. This suggests that even during times of high pressure on medical capacities, providing the full spectrum of AIS management options remains paramount.