Ischaemic stroke in patients with diabetes requiring urgent procedures during the COVID-19 pandemic in South Korea: A retrospective, nationwide, population-based cohort study using data from the National Emergency Department Information System

Min Jeong Park, Jeongeun Hwang, Jonghwa Ahn, Sung Joon Park, Eyun Song, Ahreum Jang, Kyung Mook Choi, Sei Hyun Baik, Hye Jin Yoo

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives The COVID-19 pandemic resulted in suboptimal care for ischaemic stroke. Patients with diabetes mellitus (DM), a high-risk group for stroke, had compromised routine care during the pandemic, which increases the chance of stroke. We examined influence of the COVID-19 pandemic on the management of ischaemic stroke in patients with DM in South Korea. Design Retrospective, nationwide, population-based cohort study. Setting Data from the National Emergency Department Information System. Participants We analysed 11 734 patients diagnosed with acute ischaemic stroke who underwent intravenous thrombolysis or endovascular thrombectomy between 2019 (the reference year) and 2020 (the pandemic year). Among them, 1014 subjects with DM were analysed separately. Outcome measures The frequency of emergency department (ED) visits, time from symptom onset to ED, from ED visit to admission and in-hospital mortality were compared between two periods in the overall population and in patients with DM. Results During the pandemic, the incidence of ischaemic stroke requiring urgent procedures increased by 7.57% in total and by 9.03% in patients with DM. Time delay from symptom onset to ED (reference vs pandemic, total: 1.50 vs 1.55 hours; p<0.01) and from ED visit to admission (total: 3.88 vs 3.92 hours; p=0.02) occurred during the pandemic in the overall population, but not significantly in patients with DM specifically. Older patients with DM showed higher chances of intensive care unit (ICU) admission during the pandemic: 53.5% vs 62.8% in age 70 •79, 60.5% vs 71.9% in age 80 •89 and 20.0% vs 70.8% in age ≥90 years (all p=0.01). There was no significant difference in in-hospital mortality between two periods (total: 8.2% vs 8.4%, p=0.65; DM: 8.1% vs 6.7%, p=0.25). Conclusions During the COVID-19 pandemic, the incidence of ischaemic stroke requiring urgent procedures increased, and older patients with DM showed a higher ICU admission rate. However, the pandemic was not associated with an increased in-hospital stroke mortality.

Original languageEnglish
Article numbere074381
JournalBMJ open
Volume13
Issue number12
DOIs
Publication statusPublished - 2023 Dec 13

Bibliographical note

Publisher Copyright:
© 2023 BMJ Publishing Group. All rights reserved.

Keywords

  • COVID-19
  • accident & emergency medicine
  • diabetes & endocrinology
  • stroke

ASJC Scopus subject areas

  • General Medicine

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