Efeitos da pandemia da Covid-19 nas admissões hospitalares dos pacientes com Acidente Vascular Cerebral: período pré-Pandêmico e pandêmico

Abstract

The rapid spread of the pandemic compromised the access of people affected by a cerebrovascular accident (CVA) to tertiary care due to the limited availability of beds allocated for COVID-19 cases. Health services have reorganized to care for patients with COVID-19 in relation to stroke. There was also greater occupancy of essential services for stroke diagnosis, such as the computed tomography sector as a result of diagnostic assistance for patients with COVID-19. The objectives were to compare the effects of the COVID-19 pandemic on hospital admissions of patients with stroke in the pre-pandemic and pandemic periods and to verify the association between sociodemographic and clinical variables of patients admitted with stroke during the pre-pandemic and pandemic periods. This is a comparative study carried out in a tertiary and public hospital, located in Salvador – BA. The data were from secondary sources, obtained by consulting the medical records of stroke patients admitted to the hospital in the pre-pandemic and pandemic periods, resulting in 1581 patients. The dependent variable was the period of care for the stroke victim (before the pandemic and during the pandemic) and the independent variables were: sociodemographic data (age, sex, race/color, city of residence, marital status) and clinical data of the disease (comorbidities , history of stroke, reason for hospitalization, medical diagnoses, length of stay in the Stroke Unit and other units of the hospital, date of the event and shift in which symptoms were recognized, transportation used, NIHSS at admission, whether venous thrombolysis was performed or other type of treatment and final outcome, arrival time at the hospital, CT scan time, needle door time). The data were processed using the Statistical Package for Social Sciences (SPSS), version 21.0. For analysis, descriptive statistics were used, as well as the T test, Chi-square test and Mann-Whitney test, considering a significance level of 5%. This study was approved by the ethics committee under CAAE: 55068121.4.0000.5028. The mean age of the patients was 64.6 ±14.3 years and the sample was predominantly black and mixed race. There was a statistically significant reduction in the number of single people admitted due to stroke during the pandemic. It was evident that in the periods analyzed, 81.5% of the cases were of Ischemic Stroke, 17.2% of Hemorrhagic Stroke and 1.3% of Transient Ischemic Accident. A positive result for COVID-19 was obtained in 2.3% of tests performed upon patient admission. There were more patients with dyslipidemia in the pre-pandemic period, a reduction in alcohol consumption in the pandemic and more patients with a previous stroke in the pre-pandemic period. During the pandemic, there was a statistical difference in reducing venous thrombolysis time, but with a reduction in venous thrombolysis. There was also an increase in visits through the Mobile Emergency Care Service (SAMU), of the 278 patients who underwent venous thrombolysis, 71.6% arrived at the hospital through the mobile emergency service. However, an increase in the time taken to arrive at the hospital was observed. Despite the pandemic, the results demonstrated that the reference hospital for stroke provided care comparable to the period before the pandemic. The additional training and reorganization of the care system probably guaranteed the necessary care for people affected by stroke.