Delayed Stroke Treatment during COVID-19 Pandemic in China

Gu, Shiyuan; Dai, Zhengze; Shen, Huachao; Bai, Yongjie; Zhang, Xiaohao; Liu, Xinfeng; Xu, Gelin

doi:10.1159/000517075

Cited by 23 publications

(31 citation statements)

References 19 publications

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“…What was evident in the study was the significant reduction in the proportion of patients receiving acute stroke unit admission, therefore missing out on more appropriate acute stroke care during pandemic that reaches up to approximately half compared to pre-pandemic proportions. This reduction may be possibly due to the conversion of the acute stroke unit into COVID-isolation intensive care unit and may have disrupted the chain of stroke care during pandemic which had greatly affected stroke outcomes including higher mortality seen in other studies [ 7 , 16 , 17 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic in the Acute Stroke Admissions and Outcomes in a Philippine Tertiary Hospital

Quiles

Diamante

Pascual

2022

Cerebrovasc Dis Extra

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BACKGROUND AND PURPOSE: The coronavirus 2019 (COVID-19) pandemic has been continuing its global spread ever since it’s onset and efforts to curb the infection in multiple reports have contrasting effects on stroke severity, admissions and outcomes. In the Philippines, where the COVID-19 pandemic shows no signs of slowing down and has been in the world’s longest lockdown, we investigated the effect of the pandemic in the stroke admissions and outcomes in one of the largest tertiary hospitals in the Philippines. METHODS: This is a retrospective, comparative study of all adult stroke patients admitted between Pre-COVID (February 2019-January 2020) and COVID period (February 2020-January 2021). The differences of stroke types, severity, classification, and discharge outcomes between pre-COVID and during COVID was analyzed in the study. RESULTS: There is a decrease in total number of stroke admissions from 597 in the pre-COVID period to 487 during the pandemic. Stroke patients take significantly longer time to seek hospital consultation from onset of stroke symptoms and significantly higher proportion of patients have moderate and severe stroke. The discharge outcome showed significantly higher proportions of dependency upon discharge (13%) and higher proportion of death in stroke patients from 7% pre-COVID19 pandemic to 13% during the pandemic. CONCLUSIONS: There was reduction in total stroke admissions, mild and transient stroke during the pandemic. There was significantly higher proportion of stroke patients having moderate and severe stroke. The discharge outcome of stroke patients is functionally poorer during the pandemic and more stroke patients have died compared to before COVID-19 pandemic. keywords: Stroke, Philippines, COVID-19, acute stroke

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic in the Acute Stroke Admissions and Outcomes in a Philippine Tertiary Hospital

Quiles

Diamante

Pascual

2022

Cerebrovasc Dis Extra

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“… 20 Similar trends were also observed in non-designated COVID-19 hospitals nationally in China, with higher patient NIHSS scores on admission reflecting longer DCT, DNT, and DPT. 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

“…20 Similar trends were also observed in non-designated COVID-19 hospitals nationally in China, with higher patient NIHSS scores on admission reflecting longer DCT, DNT, and DPT. 21,22 Hospitals responsible for treating COVID-19 patients for the management of pandemic had greater declines in ischemic stroke patient admissions. 18 Reasons include apprehension and reluctance to seek medical attention due to the potential risks of nosocomial contraction of COVID-19.…”

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confidence: 99%

The Impact of COVID-19 Pandemic on Ischemic Stroke Patients in a Comprehensive Hospital

Chen¹,

Nguyen²,

Siegler³

et al. 2022

RMHP

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Purpose This study aimed to investigate the impact of characteristic ischemic stroke and outcomes during the first COVID-19 pandemic lockdown. Patients and Methods A retrospective, observational cohort study of a comprehensive tertiary stroke center was conducted. Patients with ischemic stroke were divided into pre-COVID-19 lockdown (11/1/2019 to 1/30/2020) and COVID-19 lockdown (1/31/2020 to 4/30/2020) period groups. Patient data on stroke admission, thrombolysis, endovascular treatment, and 3-month routine follow-up were recorded. Data analysis was performed using SPSS according to values following a Gaussian distribution. Results The pre-COVID-19 lockdown period group comprised 230 patients compared to 215 patients in the COVID-19 lockdown period group. Atrial fibrillation was more predominant in the COVID-19 lockdown period group (11.68% vs 5.65%, p=0.02) alongside patients who were currently smoking (38.8% vs 28.7%, p=0.02) and drinking alcohol (30.37% vs 20.00%, p=0.012) compared with that of the pre-COVID-19 lockdown period group. For patients receiving thrombolysis, the median door-to-CT time was longer in the COVID-19 lockdown period group (17.0 min (13.0, 24.0) vs 12.0 min (8.0, 17.3), p=0.012), median door to needle time was 48.0 minutes (35.5, 73.0) vs 43.5 minutes (38.0, 53.3), p=0.50, compared with that of the pre-COVID-19 lockdown period group. There were no differences for patients receiving mechanical thrombectomy. The median length of hospitalization (IQR) was no different. Discharge mRS scores (IQR) were higher in the COVID-19 lockdown period group (1.0 (1.0, 3.0) vs 1.0 (1.0, 2.0), p=0.022). Compared with the pre-COVID-19 lockdown period, hospitalization cost (Chinese Yuan) in the COVID-19 period group was higher (13,445.7 (11,009.7, 20,030.5) vs 10,799.2 (8692.4, 16,381.7), p=0.000). There was no difference observed in 3-month mRS scores. Conclusion Patients presenting with ischemic stroke during the COVID-19 pandemic lockdown period had longer median door-to-CT time and higher hospitalization costs. There were no significant differences in 3-month outcomes. Multidisciplinary collaboration and continuous workflow optimization may maintain stroke care during the COVID-19 pandemic lockdown.

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“…Similarly, in a study of 19 EDs in the USA, Uchino et al 25 report approximately 30% reduction in acute stroke presentations to the ED as well as a significant reduction in acute thrombolysis procedures suggesting delays in presentation. Indeed, in a study from China, Gu et al 26 indicate significant prolongation of both pre- and post-hospital delays and significant reduction in the number of patients arriving within the time window for intravenous thrombolysis. These trends were consistent with those observed in the USA by Schirmer et al 27 , who also report significant prolongation of time to presentation of acute ischaemic strokes in the COVID-19 period compared to baseline pre-pandemic times.…”

Section: Introductionmentioning

confidence: 99%