Abstract
Background: Rapid and effective medical care for stroke is paramount to achieve maximal functional recovery. Because of the wide spreading of the coronavirus disease in 2019 (COVID-19), acute stroke care is negatively impacted. How much acute care for stroke has been affected during the pandemic remains to be assessed.Methods: The first-level response to major public health was launched from January 24th to April 29th, 2020 in Beijing to contain the spread of COVID-19. Based on a database connecting all 77 stroke centers, the quantity and quality in emergency care for stroke during the 97 lockdown days were compared with the equivalent period in 2019. During the pandemic, 15 of the 77 stroke centers were designated to receive patients sick with COVID-19. Subgroup analyses were carried out by different types of hospitals (designated and undesignated).Results: There were 1,281 and 2,354 stroke emergency hospital admissions in the lockdown period and the parallel period in 2019, respectively. A reduction of 45.6% in admission was shown in the lockdown period, with more reductions for hemorrhagic stroke (69.0%) compared with ischemic stroke (42.9%). More reductions happened in COVID-19 designated hospitals (52.6%) compared with undesignated hospitals (41.8%). The mean NIHSS score at hospital arrival was significantly higher in the lockdown period (9.4 ± 7.7 in 2020 vs. 8.4 ± 7.8 in 2019, P < 0.001). For the metrics measuring the quality of acute stroke care, the onset to door (OTD), onset to needle (ONT), and onset to recanalization (OTR) times didn't change significantly, while significant delays are shown for the door to CT scan (DTC, 1 min delay), door to needle (DTN, 4 min delays), and door to puncture (DTP, 29 min delays) times, which mainly happened in COVID-19 undesignated hospitals.Conclusions: Profound reductions in stroke hospital admissions and significant delays in emergency care for acute ischemic stroke occurred during the pandemic of COVID-19. Engagement and effective communication with all stakeholders including patients, health care providers, governmental policymakers, and other implementation partners are required for future success in similar crises.
Highlights
The coronavirus disease in 2019 (COVID-19) was declared a pandemic by the World Health Organization on 11th March 2020 [1]
We aimed to investigate the impact of the COVID-19 outbreak on stroke emergency care in Beijing during the pandemic
All emergency admissions for stroke were recorded in the database with a group of key metrics measuring the quality of acute stroke care, including time records for last known well, hospital arrival, images, intravenous thrombolysis (IVT), endovascular treatment (EVT), revascularization, and so on
Summary
The coronavirus disease in 2019 (COVID-19) was declared a pandemic by the World Health Organization on 11th March 2020 [1]. Despite the stay-at-home orders in many countries, the incidence of other conditions is not diminishing, and rapid and effective medical care for serious and life-threatening conditions, such as stroke, is still paramount to achieve maximal functional recovery. Similar academic societies in various regions and neurological physicians from different hospitals continue to make recommendations/guidelines and share treatment experiences [1, 7,8,9,10]. Despite these efforts, acute stroke care is still negatively impacted [11,12,13,14,15]. How much acute care for stroke has been affected during the pandemic remains to be assessed
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