Department of Neurology (A.S.J., P.C., I.M., R.M., M.E., Q.Z., K.N., K.V., M.A., N.P., G.J.F., P.L., N.Z., R.N., H.A., D.N., C.L., D.Y.H., J.S., S.S., K.N.S., L.H.S., R.S.), Yale University School of Medicine, New Haven, CT.
Department of Emergency Medicine (C.R.W.), Yale University School of Medicine, New Haven, CT.
Stroke. 2020 Sep;51(9):2664-2673. doi: 10.1161/STR.0000000000000347. Epub 2020 Jul 31.
Anecdotal reports suggest fewer patients with stroke symptoms are presenting to hospitals during the coronavirus disease 2019 (COVID-19) pandemic. We quantify trends in stroke code calls and treatments at 3 Connecticut hospitals during the local emergence of COVID-19 and examine patient characteristics and stroke process measures at a Comprehensive Stroke Center (CSC) before and during the pandemic.
Stroke code activity was analyzed from January 1 to April 28, 2020, and corresponding dates in 2019. Piecewise linear regression and spline models identified when stroke codes in 2020 began to decline and when they fell below 2019 levels. Patient-level data were analyzed in February versus March and April 2020 at the CSC to identify differences in patient characteristics during the pandemic.
A total of 822 stroke codes were activated at 3 hospitals from January 1 to April 28, 2020. The number of stroke codes/wk decreased by 12.8/wk from February 18 to March 16 (=0.0360) with nadir of 39.6% of expected stroke codes called from March 10 to 16 (30% decrease in total stroke codes during the pandemic weeks in 2020 versus 2019). There was no commensurate increase in within-network telestroke utilization. Compared with before the pandemic (n=167), pandemic-epoch stroke code patients at the CSC (n=211) were more likely to have histories of hypertension, dyslipidemia, coronary artery disease, and substance abuse; no or public health insurance; lower median household income; and to live in the CSC city (<0.05). There was no difference in age, sex, race/ethnicity, stroke severity, time to presentation, door-to-needle/door-to-reperfusion times, or discharge modified Rankin Scale.
Hospital presentation for stroke-like symptoms decreased during the COVID-19 pandemic, without differences in stroke severity or early outcomes. Individuals living outside of the CSC city were less likely to present for stroke codes at the CSC during the pandemic. Public health initiatives to increase awareness of presenting for non-COVID-19 medical emergencies such as stroke during the pandemic are critical.
有传闻称，在 2019 冠状病毒病（COVID-19）大流行期间，出现中风症状的患者到医院就诊的人数减少。我们在当地 COVID-19 疫情出现期间，量化了康涅狄格州 3 家医院中风急救电话的呼叫和治疗趋势，并在大流行前后在综合卒中中心（CSC）检查了患者特征和卒中进程指标。
2020 年 1 月 1 日至 4 月 28 日和 2019 年同期分析中风急救电话活动。分段线性回归和样条模型确定了 2020 年中风急救电话何时开始下降以及何时降至低于 2019 年的水平。在 2020 年 2 月和 3 月以及 4 月，在 CSC 分析了患者水平数据，以确定大流行期间患者特征的差异。
2020 年 1 月 1 日至 4 月 28 日，3 家医院共激活了 822 次中风急救电话。从 2 月 18 日到 3 月 16 日，每周中风急救电话减少了 12.8 次/周（=0.0360），3 月 10 日至 16 日的中风急救电话数量达到了最低点（2020 年大流行期间的中风急救电话总数减少了 30%）。在同期网络内远程卒中使用率并没有相应增加。与大流行前（n=167）相比，CSC 大流行期间的中风急救电话患者（n=211）更有可能患有高血压、血脂异常、冠心病和药物滥用史；没有或只有公共医疗保险；家庭收入中位数较低；居住在 CSC 市（<0.05）。年龄、性别、种族/民族、卒中严重程度、就诊时间、从进门到用药/进门到再灌注时间或出院时改良 Rankin 量表评分均无差异。
在 COVID-19 大流行期间，出现类似中风症状到医院就诊的人数减少，但卒中严重程度或早期结果无差异。居住在 CSC 市以外的人在大流行期间更不可能到 CSC 拨打中风急救电话。在大流行期间，提高对出现非 COVID-19 医疗紧急情况（如中风）的意识的公共卫生倡议非常重要。
