Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.).
Department of Neurology, University of Texas Health Science Center at Houston, TX (A.M.Z., A.L.C.).
Stroke. 2021 Jan;52(1):40-47. doi: 10.1161/STROKEAHA.120.032789. Epub 2020 Nov 30.
The pandemic caused by the novel coronavirus disease 2019 (COVID-19) has led to an unprecedented paradigm shift in medical care. We sought to evaluate whether the COVID-19 pandemic may have contributed to delays in acute stroke management at comprehensive stroke centers.
Pooled clinical data of consecutive adult stroke patients from 14 US comprehensive stroke centers (January 1, 2019, to July 31, 2020) were queried. The rate of thrombolysis for nontransferred patients within the Target: Stroke goal of 60 minutes was compared between patients admitted from March 1, 2019, and July 31, 2019 (pre-COVID-19), and March 1, 2020, to July 31, 2020 (COVID-19). The time from arrival to imaging and treatment with thrombolysis or thrombectomy, as continuous variables, were also assessed.
Of the 2955 patients who met inclusion criteria, 1491 were admitted during the pre-COVID-19 period and 1464 were admitted during COVID-19, 15% of whom underwent intravenous thrombolysis. Patients treated during COVID-19 were at lower odds of receiving thrombolysis within 60 minutes of arrival (odds ratio, 0.61 [95% CI, 0.38-0.98]; =0.04), with a median delay in door-to-needle time of 4 minutes (=0.03). The lower odds of achieving treatment in the Target: Stroke goal persisted after adjustment for all variables associated with earlier treatment (adjusted odds ratio, 0.55 [95% CI, 0.35-0.85]; <0.01). The delay in thrombolysis appeared driven by the longer delay from imaging to bolus (median, 29 [interquartile range, 18-41] versus 22 [interquartile range, 13-37] minutes; =0.02). There was no significant delay in door-to-groin puncture for patients who underwent thrombectomy (median, 83 [interquartile range, 63-133] versus 90 [interquartile range, 73-129] minutes; =0.30). Delays in thrombolysis were observed in the months of June and July.
Evaluation for acute ischemic stroke during the COVID-19 period was associated with a small but significant delay in intravenous thrombolysis but no significant delay in thrombectomy time metrics. Taking steps to reduce delays from imaging to bolus time has the potential to attenuate this collateral effect of the pandemic.
由 2019 年新型冠状病毒病（COVID-19）引起的大流行导致医疗保健发生了前所未有的范式转变。我们试图评估 COVID-19 大流行是否可能导致综合卒中中心的急性卒中管理延迟。
从美国 14 个综合卒中中心的连续成年卒中患者的汇总临床数据（2019 年 1 月 1 日至 2020 年 7 月 31 日）中查询。将 2019 年 3 月 1 日至 2019 年 7 月 31 日（COVID-19 之前）和 2020 年 3 月 1 日至 2020 年 7 月 31 日（COVID-19 期间）期间入院的非转院患者的目标：卒中 60 分钟内接受溶栓治疗的比例进行比较。还评估了从到达到进行溶栓或血栓切除术的治疗的时间，作为连续变量。
在符合纳入标准的 2955 例患者中，有 1491 例在 COVID-19 之前入院，有 1464 例在 COVID-19 期间入院，其中 15%接受了静脉溶栓治疗。在 COVID-19 期间接受治疗的患者接受 60 分钟内溶栓治疗的可能性较低（优势比，0.61[95%CI，0.38-0.98]；=0.04），到达至针的中位时间延迟了 4 分钟（=0.03）。在调整与更早治疗相关的所有变量后，达到目标：卒中治疗目标的可能性仍然较低（调整优势比，0.55[95%CI，0.35-0.85]；<0.01）。溶栓治疗的延迟似乎是由于从成像到推注的时间延长所致（中位数，29[四分位距，18-41]与 22[四分位距，13-37]分钟；=0.02）。接受血栓切除术的患者的门到腹股沟穿刺时间没有明显延迟（中位数，83[四分位距，63-133]与 90[四分位距，73-129]分钟；=0.30）。在 6 月和 7 月观察到溶栓治疗的延迟。
在 COVID-19 期间对急性缺血性卒中进行评估与静脉溶栓治疗的小但有统计学意义的延迟有关，但血栓切除术时间指标没有明显延迟。采取措施减少从成像到推注的时间延迟有可能减轻大流行的这种间接影响。
