新冠疫情期间脑卒中发病到医院就诊时间的延迟。
Delays in Stroke Onset to Hospital Arrival Time During COVID-19.
机构信息
Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong.
Division of Neurosurgery, Department of Surgery (O.N.Y.C., A.C.-O.T.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong.
出版信息
Stroke. 2020 Jul;51(7):2228-2231. doi: 10.1161/STROKEAHA.120.030105. Epub 2020 May 20.
BACKGROUND AND PURPOSE
The current coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis, disrupting emergency healthcare services. We determined whether COVID-19 has resulted in delays in stroke presentation and affected the delivery of acute stroke services in a comprehensive stroke center in Hong Kong.
METHODS
We retrospectively reviewed all patients with transient ischemic attack and stroke admitted via the acute stroke pathway of Queen Mary Hospital, Hong Kong, during the first 60 days since the first diagnosed COVID-19 case in Hong Kong (COVID-19: January 23, 2020-March 24, 2020). We compared the stroke onset to hospital arrival (onset-to-door) time and timings of inpatient stroke pathways with patients admitted during the same period in 2019 (pre-COVID-19: January 23, 2019-March 24, 2019).
RESULTS
Seventy-three patients in COVID-19 were compared with 89 patients in pre-COVID-19. There were no significant differences in age, sex, vascular risk factors, nor stroke severity between the 2 groups (>0.05). The median stroke onset-to-door time was ≈1-hour longer in COVID-19 compared with pre-COVID-19 (154 versus 95 minutes, =0.12), and the proportion of individuals with onset-to-door time within 4.5 hours was significantly lower (55% versus 72%, =0.024). Significantly fewer cases of transient ischemic attack presented to the hospital during COVID-19 (4% versus 16%, =0.016), despite no increase in referrals to the transient ischemic attack clinic. Inpatient stroke pathways and treatment time metrics nevertheless did not differ between the 2 groups (>0.05 for all comparisons).
CONCLUSIONS
During the early containment phase of COVID-19, we noted a prolongation in stroke onset to hospital arrival time and a significant reduction in individuals arriving at the hospital within 4.5 hours and presenting with transient ischemic attack. Public education about stroke should continue to be reinforced during the COVID-19 pandemic.
背景与目的
当前的 2019 年冠状病毒病（COVID-19）大流行是一场全球性的公共卫生危机，扰乱了紧急医疗服务。我们旨在确定 COVID-19 是否导致中风发作延迟，并影响香港综合中风中心的急性中风服务提供。
方法
我们回顾性分析了自香港首例 COVID-19 病例确诊（2020 年 1 月 23 日）以来的 60 天内，通过香港玛丽医院急性中风通道收治的所有短暂性脑缺血发作和中风患者（COVID-19：2020 年 1 月 23 日至 3 月 24 日）。我们比较了中风发病至入院（发病至入院）时间以及与 2019 年同期入院患者（COVID-19 前：2019 年 1 月 23 日至 3 月 24 日）的住院中风途径时间。
结果
COVID-19 组 73 例，COVID-19 前组 89 例。两组患者的年龄、性别、血管危险因素和中风严重程度无显著差异（>0.05）。COVID-19 组中风发病至入院时间比 COVID-19 前组长约 1 小时（154 分钟对 95 分钟，=0.12），发病至入院时间在 4.5 小时内的比例明显较低（55%对 72%，=0.024）。尽管向短暂性脑缺血发作诊所转诊的人数没有增加，但 COVID-19 期间就诊的短暂性脑缺血发作病例明显减少（4%对 16%，=0.016）。然而，两组患者的住院中风途径和治疗时间指标无显著差异（所有比较均>0.05）。
结论
在 COVID-19 的早期遏制阶段，我们注意到中风发病至入院时间延长，发病后 4.5 小时内入院并出现短暂性脑缺血发作的患者显著减少。在 COVID-19 大流行期间，应继续加强对中风的公众教育。
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