Delayed Stroke Treatment during COVID-19 Pandemic in China

Abstract

<b><i>Background:</i></b> Social distance, quarantine, pathogen testing, and other preventive strategies implemented during CO­VID-19 pandemic may negatively influence the management of acute ischemic stroke (AIS). <b><i>Objective:</i></b> The current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of AIS in China. <b><i>Methods:</i></b> This study included patients with AIS admitted in 2 hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 pandemic outbreak (January 31, 2020, as officially announced by the Chinese government) were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records and compared for pre- (measured as onset-to-door time [ODT]) and posthospital delay (measured as door-to-needle time [DNT]). The influencing factors for delayed treatment (indicated as onset-to-needle time &#x3e;4.5 h) were analyzed with multivariate logistic regression analysis. <b><i>Results:</i></b> A total of 252 patients were included, of which 153 (60.7%) were enrolled before and 99 (39.3%) after the COVID-19 pandemic. ODT increased from 202 min (interquartile range [IQR] 65–492) before to 317 min (IQR 75–790) after the COVID-19 pandemic (<i>p =</i> 0.001). DNT increased from 50 min (IQR 40–75) before to 65 min (IQR 48–84) after the COVID-19 pandemic (<i>p =</i> 0.048). The proportion of patients with intravenous thrombolysis in those with AIS was decreased significantly after the pandemic (15.4% vs. 20.1%; <i>p</i> = 0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms, small artery occlusion, and transported by other means than ambulance were associated with delayed treatment. <b><i>Conclusions:</i></b> COVID-19 pandemic has remarkable impacts on the management of AIS. Both pre- and posthospital delays were prolonged significantly, and proportion of patients arrived within the 4.5-h time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that the outcomes of stroke could be improved.