Kim Young Dae, Nam Hyo Suk, Sohn Sung Il, Park Hyungjong, Hong Jeong Ho, Kim Gyu Sik, Seo Kwon Duk, Yoo Joonsang, Baek Jang Hyun, Seo Jung Hwa, Heo JoonNyung, Baik Minyoul, Lee Hye Sun, Heo Ji Hoe
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea.
J Clin Neurol. 2021 Jan;17(1):63-69. doi: 10.3988/jcn.2021.17.1.63.
We aimed to determine whether the care process and outcomes in patients with acute stroke who received recanalization therapy changed during the outbreak of coronavirus disease 2019 (COVID-19) in South Korea.
We used data from a prospective multicenter reperfusion therapy registry to compare the care process-including the time from symptom onset to treatment, number of treated patients, and discharge disposition-and treatment outcomes between before and during the COVID-19 outbreak in South Korea.
Upon the COVID-19 outbreak in South Korea, the number of patients receiving endovascular treatment to decrease temporarily but considerably. The use of emergency medical services by stroke patients increased from 91.5% before to 100.0% during the COVID-19 outbreak (=0.025), as did the median time from symptom onset to hospital visit [median (interquartile range), 91.0 minutes (39.8-277.0) vs. 176.0 minutes (56.0-391.5), =0.029]. Furthermore, more functionally dependent patients with disabilities were discharged home (59.5% vs. 26.1%, =0.020) rather than staying in a regional or rehabilitation hospital. In contrast, there were no COVID-19-related changes in the times from the hospital visit to brain imaging and treatment or in the functional outcome, successful recanalization rate, or rate of symptomatic intracerebral hemorrhage.
These findings suggest that a prehospital delay occurred during the COVID-19 outbreak, and that patients with acute stroke might have been reluctant to visit and stay in hospitals. Our findings indicate that attention should be paid to prehospital care and the behavior of patients with acute stroke during the COVID-19 outbreak.
我们旨在确定在韩国2019年冠状病毒病（COVID-19）疫情期间，接受血管再通治疗的急性卒中患者的护理过程及结局是否发生了变化。
我们使用了一项前瞻性多中心再灌注治疗登记的数据，以比较韩国COVID-19疫情之前和期间的护理过程（包括从症状发作到治疗的时间、接受治疗的患者数量及出院处置情况）和治疗结局。
在韩国COVID-19疫情期间，接受血管内治疗的患者数量暂时但显著减少。卒中患者使用紧急医疗服务的比例从疫情前的91.5%增至疫情期间的100.0%（P=0.025），从症状发作到就诊的中位时间也有所增加[中位值（四分位间距），91.0分钟（39.8-277.0）对176.0分钟（56.0-391.5），P=0.029]。此外，更多功能依赖的残疾患者出院回家（59.5%对26.1%，P=0.020），而非留在地区医院或康复医院。相比之下，从就诊到脑部成像及治疗的时间、功能结局、成功再通率或症状性脑出血发生率方面，未出现与COVID-19相关的变化。
这些发现表明，在COVID-19疫情期间发生了院前延误，急性卒中患者可能不愿前往医院并住院。我们的发现提示，在COVID-19疫情期间应关注急性卒中患者的院前护理及行为。
