Abstract
Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given pre-post COVID-19 at a primary stroke centre located in Malaysia. Methods: This cross-sectional hospital-based study included adult ischaemic stroke patients. Variables of the study included the number of ischaemic stroke patients, the proportions of recanalisation therapies, stroke severity during admission based on the National Institutes of Health Stroke Scale, functional outcome at discharge based on the modified Rankin Scale, and relevant workflow metrics. We compared the outcome between two six-month periods, namely the pre-COVID-19 period (March 2019 to September 2019) and the COVID-19 period (March 2020 to September 2020). Results: There were 131 and 156 patients, respectively, from the pre-COVID-19 period and the COVID-19 period. The median door-to-scan time and the median door-to-reperfusion time were both significantly shorter in the COVID-19 period (24.5 min versus 12.0 min, p = 0.047) and (93.5 min versus 60.0 min, p = 0.015), respectively. There were also significantly more patients who received intravenous thrombolysis (7.6% versus 17.3%, p = 0.015) and mechanical thrombectomy (0.8% versus 6.4%, p = 0.013) in the COVID-19 period, respectively. Conclusions: The COVID-19 pandemic may not have caused disruptions of acute stroke care in our primary stroke centre. Our data indicated that the number of ischaemic stroke events remained stable, with a significant increase of recanalisation therapies and better in-hospital workflow metrics during the COVID-19 pandemic period. However, we would like to highlight that the burden of COVID-19 cases in the study area was very low. Therefore, the study may not have captured the true burden (and relevant delays in stroke patient management) during the COVID-19 pandemic. The effect of the pandemic crisis is ongoing and both pre-hospital and in-hospital care systems must continue to provide optimal, highly time-dependent stroke care services.
Highlights
Introduction distributed under the terms andBy witnessing the effects of the pandemic and prior to being seriously impacted by COVID-19 itself, the National Stroke Workflow Steering Committee for Malaysia performed a detailed review of the possible collateral effects of the pandemic on stroke patients in Malaysia
We embarked on this pre-post COVID-19 comparison study to assess the impact of the COVID-19 pandemic on acute stroke care services at a primary stroke centre in Malaysia
The variables of the study included the number of ischaemic stroke patients, the proportions of recanalisation therapies among ischaemic stroke patients, stroke severity during admission based on the National Institutes of Health Stroke Scale, functional outcome at discharge based on the modified Rankin Scale, and in-hospital workflow metrics such as onset-to-door time, door-to-scan time, scan-to-reperfusion time, door-toreperfusion time, and onset-to-reperfusion time
Summary
Introduction distributed under the terms andBy witnessing the effects of the pandemic and prior to being seriously impacted by COVID-19 itself, the National Stroke Workflow Steering Committee for Malaysia performed a detailed review of the possible collateral effects of the pandemic on stroke patients in Malaysia. Recent studies showed certain negative impacts of the outbreak on acute stroke care resulting in a significant drop in stroke admissions, thrombolysis, and thrombectomy cases [3,4] This does not necessarily mean that the incidence of stroke is declining and the situation could be owing to factors like patients’ fear of contracting the disease while seeking treatment at a hospital, mobility restriction due to lockdown and so forth. Other studies showed there was some evidence that stroke patients delayed seeking treatment during the pandemic [5,6] This situation, if verified, could cause severe and long-term public health implications. This study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given pre-post COVID-19 at a primary stroke centre located in Malaysia
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