Tani Takuaki, Imai Shinobu, Fushimi Kiyohide
Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan.
Neurol Res Pract. 2021 Dec 13;3(1):64. doi: 10.1186/s42466-021-00163-8.
Appropriate treatment of stroke immediately after its onset contributes to the improved chances, while delay in hospitalisation affects stroke severity and fatality. This study aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on emergency hospitalisation of patients with stroke in Japan.
This was an observational study that used nationwide administrative data of hospitalised patients diagnosed with stroke. We cross-sectionally observed patients' background factors during April and May 2020, when the COVID-19 pandemic-related state of emergency was declared; we also observed these factors in the same period in 2019. We also modelled monthly trends in emergency stroke admissions, stroke admissions at each level of the Japan Coma Scale (JCS), fatalities within 24 h, stroke care unit use, intravenous thrombolysis administration, and mechanical thrombectomy implementation using interrupted time series (ITS) regression.
There was no difference in patients' pre-hospital baseline characteristics between the pre-pandemic and pandemic periods. However, ITS regression revealed a significant change in the number of emergency stroke admissions after the beginning of the pandemic (slope: risk ratio [RR] = 0.97, 95% confidence interval [CI]: 0.95-0.99, P = 0.027). There was a significant difference in the JCS score for impaired consciousness in emergency stroke, which was more severe during the pandemic than the pre-pandemic (JCS3 in level: RR = 1.75, 95% CI: 1.29-2.33, P < 0.001). There was no change in the total number of fatalities with COVID-19, compared with those without COVID-19, but there were significantly more fatalities within 24 h of admission (fatalities within 24 h: RR = 1.75, 95% CI: 1.29-2.33, P < 0.001).
The infection prevalence of COVID-19 increased the number of fatalities within 24 h as well as the severity of illness in Japan. However, there was no difference in baseline characteristics, intravenous thrombolysis administration, and mechanical thrombectomy implementation during the COVID-19 pandemic. A decrease in the number of patients and fatalities was observed from the time the state of emergency was declared until August, the period of this study.
中风发作后立即进行适当治疗有助于提高康复几率，而住院延迟会影响中风的严重程度和死亡率。本研究旨在确定2019年冠状病毒病（COVID-19）大流行对日本中风患者紧急住院治疗的影响。
这是一项观察性研究，使用了全国范围内确诊为中风的住院患者的行政数据。我们对2020年4月和5月（当时宣布了与COVID-19大流行相关的紧急状态）期间患者的背景因素进行了横断面观察；我们还观察了2019年同期的这些因素。我们还使用中断时间序列（ITS）回归对紧急中风入院的月度趋势、日本昏迷量表（JCS）各等级的中风入院情况、24小时内的死亡率、中风监护病房的使用情况、静脉溶栓治疗的实施情况以及机械取栓术的实施情况进行了建模。
大流行前和大流行期间患者的院前基线特征没有差异。然而，ITS回归显示大流行开始后紧急中风入院人数有显著变化（斜率：风险比[RR]=0.97，95%置信区间[CI]：0.95-0.99，P=0.027）。紧急中风中意识障碍的JCS评分存在显著差异，大流行期间比大流行前更严重（JCS3等级：RR=1.75，95%CI：1.29-2.33，P<0.001）。与未感染COVID-19的患者相比，感染COVID-19的患者总死亡人数没有变化，但入院24小时内的死亡人数显著增加（24小时内死亡人数：RR=1.75，95%CI：1.29-2.33，P<0.001）。
在日本，COVID-19的感染率增加了24小时内的死亡人数以及疾病的严重程度。然而，在COVID-19大流行期间，基线特征、静脉溶栓治疗的实施情况和机械取栓术的实施情况没有差异。从宣布紧急状态到本研究的8月期间，观察到患者人数和死亡人数有所下降。
