Delays in Stroke Onset to Hospital Arrival Time During COVID-19
Delays in Stroke Onset to Hospital Arrival Time During COVID-19
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DOI：
10.1161/strokeaha.120.030105
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发表时间：
2020-07-01
期刊：
影响因子：
8.3
通讯作者：
Lau, Kui Kai
中科院分区：
文献类型：
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作者：
Teo, Kay-Cheong;Leung, William C. Y.;Lau, Kui Kai
背景和目的：当前的 2019 年冠状病毒病 (COVID-19) 大流行代表了一场全球公共卫生危机，扰乱了紧急医疗服务。我们确定了 COVID-19 是否导致中风就诊延迟并影响了香港综合中风中心提供的急性中风服务。方法：我们回顾性分析了自香港首例确诊的 COVID-19 病例以来的 60 天内（COVID-19：2020 年 1 月 23 日至 2020 年 3 月 24 日）通过香港玛丽医院急性中风途径入院的所有短暂性脑缺血发作和中风患者。我们比较了2019年同期（COVID-19之前：2019年1月23日至2019年3月24日）入院患者的中风发病到入院（发病到就诊）时间以及住院中风路径的时间安排。结果：将 73 名 COVID-19 患者与 89 名 COVID-19 之前的患者进行了比较。两组患者年龄、性别、血管危险因素、脑卒中严重程度差异均无统计学意义（P>0.05）。与 COVID-19 之前相比，COVID-19 期间卒中发病到就诊时间中位数大约长了 1 小时（154 分钟 vs 95 分钟，P=0.12），并且发病到就诊时间在 4.5 小时内的个体比例显着降低（55% vs 72%，P=0.024）。尽管转诊至短暂性脑缺血发作诊所的人数没有增加，但在 COVID-19 期间到医院就诊的短暂性脑缺血发作病例却显着减少（分别为 4% 和 16%，P=0.016）。然而，两组之间的住院卒中路径和治疗时间指标没有差异（所有比较 P>0.05）。结论：在 COVID-19 的早期遏制阶段，我们注意到中风发病至到达医院的时间延长，并且 4.5 小时内到达医院并出现短暂性脑缺血发作的人数显着减少。在 COVID-19 大流行期间，应继续加强有关中风的公众教育。
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 approximate to 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.