Ghoreishi Abdoreza, Arsang-Jang Shahram, Sabaa-Ayoun Ziad, Yassi Nawaf, Sylaja P N, Akbari Yama, Divani Afshin A, Biller Jose, Phan Thanh, Steinwender Sandy, Silver Brian, Zand Ramin, Basri Hamidon Bin, Iqbal Omer M, Ranta Annemarei, Ruland Sean, Macri Elizabeth, Ma Henry, Nguyen Thanh N, Abootalebi Shahram, Gupta Animesh, Alet Matias, Lattanzi Simona, Desai Masoom, Gagliardi Rubens J, Girotra Tarun, Inoue Manabu, Yoshimoto Takeshi, Isaac Cristian Flavo, Mayer Stephan A, Morovatdar Negar, Nilanont Yongchai, Nobleza Christa O'Hana S, Saber Hamidreza, Kamenova Saltanat, Kondybayeva Aida, Krupinski Jerzy, Siegler James E, Stranges Saverio, Torbey Michel T, Yorio Diana, Zurrú María Cristina, Rubinos Clio Aracelli, Shahripour Reza Bavarsad, Borhani-Haghighi Afshin, Napoli Mario Di, Azarpazhooh M Reza
Stroke Research Group, Department of Neurology and Stroke Unit, Vali-e-Asr hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105321. doi: 10.1016/j.jstrokecerebrovasdis.2020.105321. Epub 2020 Sep 16.
The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran.
This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model.
During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001).
In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admission rates for milder stroke may possibly be due to fear of exposure related to COVID-19. The decrease in patients treated with thrombolysis and the increased disability at discharge may indicate changes in the delivery of stroke care and increased pressure on existing stroke acute and subacute services. The results of this research will contribute to a similar analysis of the larger CASCADE dataset in order to confirm findings at a global scale and improve measures to ensure the best quality of care for stroke patients during the COVID-19 pandemic.
新型冠状病毒肺炎疫情的出现对全球医疗系统产生了重大影响，这可能会影响中风护理及治疗结果。本研究调查了伊朗赞詹省在新型冠状病毒肺炎疫情期间中风流行病学及护理的变化情况。
本研究是“全球急性中风研究协作组（CASCADE）”国际倡议的一部分。2019年2月18日至2020年7月18日，我们追踪了伊朗赞詹省瓦利阿斯尔医院缺血性和出血性中风的住院率及治疗结果。我们使用贝叶斯分层模型和中断时间序列分析（ITS）来确定中风住院率、基线中风严重程度[通过美国国立卫生研究院中风量表（NIHSS）测量]、残疾程度[通过改良Rankin量表（mRS）测量]、就诊时间（最后一次正常状态至入院时间）、溶栓治疗率、中位门到针时间、住院时间和院内死亡率的变化。我们使用Cox回归模型比较了研究期间的院内死亡率。
在研究期间，1026例中风患者住院治疗。每10万人口的中风住院率从疫情前的68.09降至疫情期间的44.50，贝叶斯分析[贝塔值：-1.034；标准误（SE）：0.22，95%可信区间：-1.48，-0.59]和ITS分析均显示显著下降（估计值：-1.03，SE = 0.24，p < 0.0001）。此外，我们观察到轻度（NIHSS < 5）缺血性中风患者的入院率较低（p < 0.0001）。尽管在疫情期间就诊时间和门到针时间没有变化，但接受溶栓治疗的患者比例较低（-10.1%；p = 0.004）。我们未观察到中风单元的入院率和院内死亡率有显著变化；然而，出院时的残疾程度有所增加（p < 0.0001）。
在伊朗赞詹，新型冠状病毒肺炎疫情对中风治疗结果产生了重大影响，并改变了中风护理的提供方式。观察到较轻中风患者入院率较低可能是由于对新型冠状病毒肺炎感染风险的担忧。溶栓治疗患者数量减少以及出院时残疾程度增加可能表明中风护理提供方式发生了变化，现有中风急性和亚急性服务压力增大。本研究结果将有助于对更大规模的CASCADE数据集进行类似分析，以在全球范围内确认研究结果，并改进措施以确保在新型冠状病毒肺炎疫情期间为中风患者提供最佳护理质量。
