Delays in Presentation Time Under the COVID-19 Epidemic in Patients With Transient Ischemic Attack and Mild Stroke: A Retrospective Study of Three Hospitals in a Japanese Prefecture

Abstract

Background: Coronavirus Disease 2019 (COVID-19) has spread worldwide with collateral damage and therefore might affect the behavior of stroke patients with mild symptoms seeking medical attention.Methods: Patients with ischemic stroke who were admitted to hospitals within 7 days of onset were retrospectively registered. The clinical characteristics, including onset-to-door time (ODT), of patients with a transient ischemic attack (TIA)/mild stroke (National Institutes of Health Stroke Scale [NIHSS] score of ≤ 3 on admission) or moderate/severe stroke were compared between those admitted from April 2019 to March 2020 (pre-COVID-19 period) and from April to September 2020 (COVID-19 period). Multivariable regression analysis was performed to identify factors associated with the ODT.Results: Of 1,100 patients (732 men, median age, 73 years), 754 were admitted during the pre-COVID-19 period, and 346 were admitted during the COVID-19 period. The number and proportion of patients with TIA/minor stroke were 464 (61.5%) in the pre-COVID-19 period and 216 (62.4%) during the COVID-19 period. Among patients with TIA/mild stroke, the ODT was longer in patients admitted during the COVID-19 period compared with that of the pre-COVID-19 period (median 864 min vs. 508 min, p = 0.003). Multivariable analysis revealed the COVID-19 period of admission was associated with longer ODT (standardized partial regression coefficient 0.09, p = 0.003) after adjustment for age, sex, route of arrival, NIHSS score on admission, and the presence of hypertension, diabetes mellitus, and wake-up stroke. No significant change in the ODT was seen in patients with moderate/severe stroke.Conclusions: The COVID-19 epidemic might increase the ODT of patients with TIA/mild stroke.

Impact of the COVID‐19 pandemic on epidemiology, treatment, and outcome of major trauma in Japan in 2020: a retrospective observational nationwide registry‐based study

“…Under the COVID‐19 pandemic, several studies in Japan reported that the time for prehospital care increased for patients with out‐of‐hospital cardiac arrest, acute myocardial infarction, and stroke. 23 , 24 , 25 However, a study dealing with the victims of traffic accidents in the early stage of the COVID‐19 pandemic found no change in the time for prehospital care. 3 In the present study dealing with major trauma, the time for prehospital care increased significantly in 2020 compared to 2019.…”

Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study

“…In addition, as a global health crisis, the COVID-19 pandemic has been the most serious challenge to delivering timely care to patients with other conditions [ 7 ]. Its outbreak proved to have a major impact on patients with cerebrovascular diseases [ 8 , 9 ], for example, significantly decreasing the rate of stroke admissions [ 10 , 11 ], intravenous thrombolysis and mechanical thrombectomy [ 12 , 13 ], and prolonging the time from symptom onset to treatment of ischemic stroke [ 14 ]. Intracerebral hemorrhage (ICH), one of the most devastating diseases worldwide with a mortality rate of up to twice that of ischemic stroke [ 15 ], requires emergency medical care in specialized neurological intensive care units [ 16 ].…”

Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study (Preprint)

“…In addition, as a global health crisis, the COVID-19 pandemic has been the most serious challenge to delivering timely care to patients with other conditions [7]. Its outbreak proved to have a major impact on patients with cerebrovascular diseases [8,9], for example, significantly decreasing the rate of stroke admissions [10,11], intravenous thrombolysis and mechanical thrombectomy [12,13], and prolonging the time from symptom onset to treatment of ischemic stroke [14]. Intracerebral hemorrhage (ICH), one of the most devastating diseases worldwide with a mortality rate of up to twice that of ischemic stroke [15], requires emergency medical care in specialized neurological intensive care units [16].…”