Stroke Delays in Stroke Onset to Hospital Arrival Time During COVID-19

[tetano]

Stroke


. 2020 May 20;STROKEAHA120030105.
doi: 10.1161/STROKEAHA.120.030105. Online ahead of print.
Delays in Stroke Onset to Hospital Arrival Time During COVID-19


Kay-Cheong Teo[SUP] 1 [/SUP], William C Y Leung[SUP] 1 [/SUP], Yuen-Kwun Wong[SUP] 1 [/SUP], Roxanna K C Liu[SUP] 1 [/SUP], Anna H Y Chan[SUP] 1 [/SUP], Olivia M Y Choi[SUP] 2 [/SUP], Wing-Man Kwok[SUP] 3 [/SUP], Kung-Ki Leung[SUP] 1 [/SUP], Man-Yu Tse[SUP] 1 [/SUP], Raymond T F Cheung[SUP] 1 [/SUP], Anderson Chun-On Tsang[SUP] 2 [/SUP], Kui Kai Lau[SUP] 1 [/SUP]



Affiliations

• PMID: 32432998
• DOI: 10.1161/STROKEAHA.120.030105

Abstract

Background and purpose: The current coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis, disrupting emergency healthcare services. We determined whether COVID-19 has resulted in delays in stroke presentation and affected the delivery of acute stroke services in a comprehensive stroke center in Hong Kong.
Methods: We retrospectively reviewed all patients with transient ischemic attack and stroke admitted via the acute stroke pathway of Queen Mary Hospital, Hong Kong, during the first 60 days since the first diagnosed COVID-19 case in Hong Kong (COVID-19: January 23, 2020-March 24, 2020). We compared the stroke onset to hospital arrival (onset-to-door) time and timings of inpatient stroke pathways with patients admitted during the same period in 2019 (pre-COVID-19: January 23, 2019-March 24, 2019).
Results: Seventy-three patients in COVID-19 were compared with 89 patients in pre-COVID-19. There were no significant differences in age, sex, vascular risk factors, nor stroke severity between the 2 groups (P>0.05). The median stroke onset-to-door time was ≈1-hour longer in COVID-19 compared with pre-COVID-19 (154 versus 95 minutes, P=0.12), and the proportion of individuals with onset-to-door time within 4.5 hours was significantly lower (55% versus 72%, P=0.024). Significantly fewer cases of transient ischemic attack presented to the hospital during COVID-19 (4% versus 16%, P=0.016), despite no increase in referrals to the transient ischemic attack clinic. Inpatient stroke pathways and treatment time metrics nevertheless did not differ between the 2 groups (P>0.05 for all comparisons).
Conclusions: During the early containment phase of COVID-19, we noted a prolongation in stroke onset to hospital arrival time and a significant reduction in individuals arriving at the hospital within 4.5 hours and presenting with transient ischemic attack. Public education about stroke should continue to be reinforced during the COVID-19 pandemic.

Keywords: coronavirus disease; public health; stroke.

 

[tetano]

Stroke


. 2020 May 20;STROKEAHA120030225.
doi: 10.1161/STROKEAHA.120.030225. Online ahead of print.
Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions


Jing Zhao[SUP] 1 [/SUP], Hang Li[SUP] 2 [/SUP], David Kung[SUP] 3 [/SUP], Marc Fisher[SUP] 4 [/SUP], Ying Shen[SUP] 5 [/SUP], Renyu Liu[SUP] 6 [/SUP]



Affiliations

• PMID: 32432997
• DOI: 10.1161/STROKEAHA.120.030225

Abstract

Background and Purpose- When the coronavirus disease 2019 (COVID-19) outbreak became paramount, medical care for other devastating diseases was negatively impacted. In this study, we investigated the impact of the COVID-19 outbreak on stroke care across China. Methods- Data from the Big Data Observatory Platform for Stroke of China consisting of 280 hospitals across China demonstrated a significant drop in the number of cases of thrombolysis and thrombectomy. We designed a survey to investigate the major changes during the COVID-19 outbreak and potential causes of these changes. The survey was distributed to the leaders of stroke centers in these 280 hospitals. Results- From the data of Big Data Observatory Platform for Stroke of China, the total number of thrombolysis and thrombectomy cases dropped 26.7% (P<0.0001) and 25.3% (P<0.0001), respectively, in February 2020 as compared with February 2019. We retrieved 227 valid complete datasets from the 280 stroke centers. Nearly 50% of these hospitals were designated hospitals for COVID-19. The capacity for stroke care was reduced in the majority of the hospitals. Most of the stroke centers stopped or reduced their efforts in stroke education for the public. Hospital admissions related to stroke dropped ≈40%; thrombolysis and thrombectomy cases dropped ≈25%, which is similar to the results from the Big Data Observatory Platform for Stroke of China as compared with the same period in 2019. Many factors contributed to the reduced admissions and prehospital delays; lack of stroke knowledge and proper transportation were significant limiting factors. Patients not coming to the hospital for fear of virus infection was also a likely key factor. Conclusions- The COVID-19 outbreak impacted stroke care significantly in China, including prehospital and in-hospital care, resulting in a significant drop in admissions, thrombolysis, and thrombectomy. Although many factors contributed, patients not coming to the hospital was probably the major limiting factor. Recommendations based on the data are provided.

Keywords: coronavirus; humans; infections; stroke; thrombectomy.