The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Department of Neurology, Shanghai East Hospital, Shanghai, Shanghai, China.
Stroke Vasc Neurol. 2020 Dec;5(4):323-330. doi: 10.1136/svn-2020-000514. Epub 2020 Sep 28.
The COVID-19 pandemic and physical distancing guidelines have compelled stroke practices worldwide to reshape their delivery of care significantly. We aimed to illustrate how the stroke services were interrupted during the pandemic in China.
A 61-item questionnaire designed on Wenjuanxing Form was completed by doctors or nurses who were involved in treating patients with stroke from 1 February to 31 March 2020.
A total of 415 respondents completed the online survey after informed consent was obtained. Of the respondents, 37.8%, 35.2% and 27.0% were from mild, moderate and severe epidemic areas, respectively. Overall, the proportion of severe impact (reduction >50%) on the admission of transient ischaemic stroke, acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH) was 45.0%, 32.0% and 27.5%, respectively. Those numbers were 36.9%, 27.9% and 22.3%; 36.5%, 22.1% and 22.6%; and 66.4%, 47.5% and 41.1% in mild, moderate and severe epidemic areas, respectively (all p<0.0001). For AIS, thrombolysis was moderate (20%-50% reduction) or severely impacted (>50%), as reported by 54.4% of the respondents, while thrombectomy was 39.3%. These were 44.4%, 26.3%; 44.2%, 39.4%; and 78.2%, 56.5%, in mild, moderate and severe epidemic areas, respectively (all p<0.0001). For patients with acute ICH, 39.8% reported the impact was severe or moderate for those eligible for surgery who had surgery. Those numbers were 27.4%, 39.0% and 58.1% in mild, moderate and severe epidemic areas, respectively. For staff resources, about 20% (overall) to 55% (severe epidemic) of the respondents reported moderate or severe impact on the on-duty doctors and nurses.
We found a significant reduction of admission for all types of patients with stroke during the pandemic. Patients were less likely to receive appropriate care, for example, thrombolysis/thrombectomy, after being admitted to the hospital. Stroke service in severe COVID-19 epidemic areas, for example, Wuhan, was much more severely impacted compared with other regions in China.
COVID-19 大流行和身体距离指导原则迫使全球的中风实践显著改变了其护理方式。我们旨在说明在中国大流行期间中风服务是如何中断的。
2 月 1 日至 3 月 31 日期间，参与治疗中风患者的医生或护士使用问卷星表单完成了一份 61 项的问卷。
在获得知情同意后，共有 415 名受访者完成了在线调查。在受访者中，分别有 37.8%、35.2%和 27.0%来自轻度、中度和重度流行地区。总体而言，短暂性脑缺血发作、急性缺血性中风（AIS）和脑出血（ICH）的入院严重影响（减少>50%）的比例分别为 45.0%、32.0%和 27.5%。这些数字分别为 36.9%、27.9%和 22.3%；36.5%、22.1%和 22.6%；和 66.4%、47.5%和 41.1%，分别来自轻度、中度和重度流行地区（均 p<0.0001）。对于 AIS，54.4%的受访者报告溶栓治疗受到中度（20%-50%减少）或严重影响（>50%），而取栓术为 39.3%。这些数字分别为 44.4%、26.3%；44.2%、39.4%和 78.2%、56.5%，分别来自轻度、中度和重度流行地区（均 p<0.0001）。对于急性 ICH 患者，39.8%的受访者报告称，对于有手术适应证的手术患者，手术的影响严重或中度。这些数字分别为 27.4%、39.0%和 58.1%，来自轻度、中度和重度流行地区。对于员工资源，大约 20%（整体）至 55%（重度流行地区）的受访者报告称，在职医生和护士受到中度或严重影响。
我们发现大流行期间所有类型的中风患者的入院人数均显著减少。患者在入院后接受适当治疗的可能性降低，例如溶栓/取栓治疗。与中国其他地区相比，武汉等 COVID-19 疫情严重地区的中风服务受到的影响要严重得多。
