Department of Neurointerventional Surgery, Ascension Columbia St. Mary's Hospital, Milwaukee, WI.
Neuroendovascular Surgery and Vascular Neurology, AMITA Health Medical Group, Chicago, IL.
J Stroke Cerebrovasc Dis. 2021 Jun;30(6):105569. doi: 10.1016/j.jstrokecerebrovasdis.2020.105569. Epub 2020 Dec 26.
Delayed evaluation of stroke may contribute to COVID-19 pandemic-related morbidity and mortality. This study evaluated patient characteristics, process measures and outcomes associated with the decline in stroke presentation during the early pandemic.
Volumes of stroke presentations, intravenous thrombolytic administrations, and mechanical thrombectomies from 52 hospitals from January 1-June 30, 2020 were analyzed with piecewise linear regression and linear spline models. Univariate analysis compared pandemic (case) and pre-pandemic (control) groups defined in relation to the nadir of daily strokes during the study period. Significantly different patient characteristics were further evaluated with logistic regression, and significantly different process measures and outcomes were re-analyzed after propensity score matching.
Analysis of 7,389 patients found daily stroke volumes decreased 0.91/day from March 12-26 (p < 0.0001), reaching a nadir 35.0% less than expected, and increased 0.15 strokes/day from March 27-June 23, 2020 (p < 0.0001). Intravenous thrombolytic administrations decreased 3.3/week from February 19-March 31 (p = 0.0023), reaching a nadir 33.4% less than expected, and increased 1.4 administrations/week from April 1-June 23 (p < 0.0001). Mechanical thrombectomy volumes decreased by 1.5/week from February 19-March 31, 2020 (p = 0.0039), reaching a nadir 11.3% less than expected. The pandemic group was more likely to ambulate independently at baseline (p = 0.02, OR = 1.60, 95% CI = 1.08-2.42), and less likely to present with mild stroke symptoms (NIH Stroke Scale ≤ 5; p = 0.04, OR = 1.01, 95% CI = 1.00-1.02). Process measures and outcomes of each group did not differ, including door-to-needle time, door-to-puncture time, and successful mechanical thrombectomy rate.
Stroke presentations and acute interventions decreased during the early COVID-19 pandemic, at least in part due to patients with lower baseline functional status and milder symptoms not seeking medical care. Public health messaging and initiatives should target these populations.
对卒中的延迟评估可能导致与 COVID-19 大流行相关的发病率和死亡率。本研究评估了大流行早期卒中就诊减少与患者特征、治疗流程和结局的相关性。
分析了 2020 年 1 月 1 日至 6 月 30 日 52 家医院的卒中就诊量、静脉溶栓治疗和机械取栓治疗，使用分段线性回归和线性样条模型。根据研究期间每日卒中量的最低点，将病例组（大流行期）和对照组（大流行前）进行分组。采用单变量分析比较两组患者的特征，对差异有统计学意义的特征采用逻辑回归分析，并在进行倾向评分匹配后重新分析差异有统计学意义的治疗流程和结局。
对 7389 例患者进行分析发现，自 3 月 12 日至 26 日，每日卒中量减少 0.91 例（p＜0.0001），至研究期间的最低点，较预期减少 35.0%，自 3 月 27 日至 6 月 23 日，每日卒中量增加 0.15 例（p＜0.0001）。静脉溶栓治疗自 2 月 19 日至 3 月 31 日每周减少 3.3 例（p=0.0023），至最低点，较预期减少 33.4%，自 4 月 1 日至 6 月 23 日每周增加 1.4 例（p＜0.0001）。机械取栓治疗自 2 月 19 日至 3 月 31 日每周减少 1.5 例（p=0.0039），至最低点，较预期减少 11.3%。病例组患者基线时更有可能独立行走（p=0.02，OR=1.60，95%CI=1.08-2.42），更不可能出现轻度卒中症状（NIH 卒中量表评分≤5；p=0.04，OR=1.01，95%CI=1.00-1.02）。两组的治疗流程和结局均无差异，包括门到针时间、门到穿刺时间和机械取栓成功的比例。
至少在一定程度上，由于基线功能状态较低和症状较轻的患者未寻求医疗救治，COVID-19 大流行早期的卒中就诊和急性治疗减少。公共卫生宣传和干预措施应针对这些人群。
