Kim Tae Jung, Kim Beom Joon, Gwak Dong-Seok, Lee Ji Sung, Kim Jun Yup, Lee Keon-Joo, Kwon Jung-A, Shim Dong-Hyun, Kim Yong-Won, Kang Min Kyoung, Lee Eung-Jun, Nam Ki-Woong, Bae Jeonghoon, Jeon Kipyoung, Jeong Han-Yeong, Jung Keun-Hwa, Hwang Yang-Ha, Bae Hee-Joon, Yoon Byung-Woo, Ko Sang-Bae
Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Department of Critical Care Medicine, Seoul National University Hospital, Seoul, South Korea.
Front Neurol. 2020 Nov 19;11:597785. doi: 10.3389/fneur.2020.597785. eCollection 2020.
Since the global pandemic of coronavirus disease 2019 (COVID-19), the process of emergency medical services has been modified to ensure the safety of healthcare professionals as well as patients, possibly leading to a negative impact on the timely delivery of acute stroke care. This study aimed to assess the impact of the COVID-19 pandemic on the acute stroke care processes and outcomes in tertiary COVID-19-dedicated centers in South Korea. We included 1,213 patients with acute stroke admitted to three centers in three cities (Seoul, Seongnam, and Daegu) through the stroke critical pathway between September 2019 and May 2020 (before and during the COVID-19 pandemic). In all three centers, we collected baseline characteristics and parameters regarding the stroke critical pathway, including the number of admitted patients diagnosed with acute stroke through the stroke critical pathway, door to brain imaging time, door to intravenous recombinant tissue plasminogen activator time, door to groin puncture time, and door to admission time. We performed an interrupted time series analysis to determine the impact of the COVID-19 outbreak on outcomes and critical pathway parameters. Three centers modified the protocol of the stroke critical pathway during the COVID-19 pandemic. There was an immediate decrease in the number of patients admitted with acute ischemic stroke after the outbreak of COVID-19 in Korea, especially in the center of Daegu, an epicenter of the COVID-19 outbreak. However, the number of patients with stroke soon increased to equal that before the Covid-19 outbreak. In several critical pathway parameters, door to imaging time showed a temporary increase, and door to admission was transiently decreased after the COVID-19 outbreak. However, there was no significant effect on the timely trend. Moreover, there was no significant difference in the baseline characteristics and clinical outcomes between the periods before and during the COVID-19 pandemic. This study demonstrated that the COVID-19 outbreak immediately affected the management process. However, it did not have a significant overall impact on the trends of stroke treatment processes and outcomes. The stroke management process should be modified according to changing situations for optimal acute management.
自2019年冠状病毒病（COVID-19）全球大流行以来，紧急医疗服务流程已进行调整，以确保医护人员和患者的安全，这可能会对急性中风护理的及时提供产生负面影响。本研究旨在评估COVID-19大流行对韩国三级COVID-19专科医院急性中风护理流程及结果的影响。我们纳入了2019年9月至2020年5月（COVID-19大流行之前及期间）通过中风关键路径入住三个城市（首尔、城南和大邱）的三个中心的1213例急性中风患者。在所有三个中心，我们收集了有关中风关键路径的基线特征和参数，包括通过中风关键路径确诊为急性中风的入院患者数量、门到脑成像时间、门到静脉注射重组组织型纤溶酶原激活剂时间、门到腹股沟穿刺时间和门到入院时间。我们进行了中断时间序列分析，以确定COVID-19疫情对结果和关键路径参数的影响。在COVID-19大流行期间，三个中心修改了中风关键路径的方案。韩国COVID-19疫情爆发后，急性缺血性中风入院患者数量立即减少，尤其是在COVID-19疫情的中心大邱市的中心。然而，中风患者数量很快增加到与COVID-19疫情爆发前相当的水平。在几个关键路径参数方面，门到成像时间出现了暂时增加，COVID-19疫情爆发后门到入院时间短暂缩短。然而，对及时趋势没有显著影响。此外，COVID-19大流行之前和期间的基线特征和临床结果没有显著差异。本研究表明，COVID-19疫情立即影响了管理流程。然而，它对中风治疗流程和结果的趋势没有显著的总体影响。应根据情况变化修改中风管理流程，以实现最佳的急性管理。
