Calgary Stroke Program, Department of Clinical Neurosciences (Ganesh, Holodinsky, Hill, Smith); Departments of Radiology, and of Community Health Sciences (Ganesh, Hill, Smith), Cumming School of Medicine, University of Calgary; Hotchkiss Brain Institute (Ganesh, Hill, Smith); Foothills Medical Centre (Ganesh, Holodinsky, Hill, Smith), Alberta Health Services, Calgary, Alta.; Alberta Health Services (Stang), Red Deer, Alta.; Division of General Internal Medicine, Faculty of Medicine and Dentistry (McAlister), University of Alberta; Alberta Health Services (Shlakhter, Mann); Cardiovascular Health and Stroke Strategic Clinical Network (Mann), Alberta Health Services, Edmonton, Alta.; Department of Medicine (Hill), Cumming School of Medicine, University of Calgary, Calgary, Alta.
CMAJ. 2022 Mar 28;194(12):E444-E455. doi: 10.1503/cmaj.211003.
Pandemics may promote hospital avoidance, and added precautions may exacerbate treatment delays for medical emergencies such as stroke. We sought to evaluate ischemic stroke presentations, management and outcomes during the first year of the COVID-19 pandemic.
We conducted a population-based study, using linked administrative and stroke registry data from Alberta to identify all patients presenting with stroke before the pandemic (Jan. 1, 2016 to Feb. 27, 2020) and in 5 periods over the first pandemic year (Feb. 28, 2020 to Mar. 31, 2021), reflecting changes in case numbers and restrictions. We evaluated changes in hospital admissions, emergency department presentations, thrombolysis, endovascular therapy, workflow times and outcomes.
The study included 19 531 patients in the prepandemic period and 4900 patients across the 5 pandemic periods. Presentations for ischemic stroke dropped in the first pandemic wave (weekly adjusted incidence rate ratio [IRR] 0.54, 95% confidence interval [CI] 0.50 to 0.59). Population-level incidence of thrombolysis (adjusted IRR 0.50, 95% CI 0.41 to 0.62) and endovascular therapy (adjusted IRR 0.63, 95% CI 0.47 to 0.84) also decreased during the first wave, but proportions of patients presenting with stroke who received acute therapies did not decline. Rates of patients presenting with stroke did not return to prepandemic levels, even during a lull in COVID-19 cases between the first 2 waves of the pandemic, and fell further in subsequent waves. In-hospital delays in thrombolysis or endovascular therapy occurred in several pandemic periods. The likelihood of in-hospital death increased in Wave 2 (adjusted odds ratio [OR] 1.48, 95% CI 1.25 to 1.74) and Wave 3 (adjusted OR 1.46, 95% CI 1.07 to 2.00). Out-of-hospital deaths, as a proportion of stroke-related deaths, rose during 4 of 5 pandemic periods.
The first year of the COVID-19 pandemic saw persistently reduced rates of patients presenting with ischemic stroke, recurrent treatment delays and higher risk of in-hospital death in later waves. These findings support public health messaging that encourages care-seeking for medical emergencies during pandemic periods, and stroke systems should re-evaluate protocols to mitigate inefficiencies.
大流行可能会导致人们回避医院，而额外的预防措施可能会加剧医疗紧急情况（如中风）的治疗延误。我们试图评估 COVID-19 大流行第一年中风的表现、治疗和结局。
我们进行了一项基于人群的研究，使用艾伯塔省的行政和中风登记数据，确定了大流行前（2016 年 1 月 1 日至 2020 年 2 月 27 日）和大流行第一年的 5 个时期（2020 年 2 月 28 日至 2021 年 3 月 31 日）所有出现中风的患者，反映了病例数量和限制的变化。我们评估了住院、急诊科就诊、溶栓、血管内治疗、工作流程时间和结局的变化。
本研究包括大流行前的 19531 名患者和 5 个大流行时期的 4900 名患者。第一次大流行浪潮中，缺血性中风的就诊人数下降（每周调整后的发病率比[IRR]为 0.54，95%置信区间[CI]为 0.50 至 0.59）。溶栓（调整后的 IRR 为 0.50，95%CI 为 0.41 至 0.62）和血管内治疗（调整后的 IRR 为 0.63，95%CI 为 0.47 至 0.84）的人群水平发生率也在第一次浪潮期间下降，但接受急性治疗的中风患者比例并未下降。即使在 COVID-19 前两波之间的大流行期间出现了一个平静期，中风患者的就诊率也没有恢复到大流行前的水平，并且在随后的浪潮中进一步下降。在几个大流行时期，溶栓或血管内治疗的院内延迟发生。在第 2 波（调整后的优势比[OR]为 1.48，95%CI 为 1.25 至 1.74）和第 3 波（调整后的 OR 为 1.46，95%CI 为 1.07 至 2.00）中，院内死亡的可能性增加。在 5 个大流行时期中的 4 个时期，院外死亡占中风相关死亡的比例上升。
COVID-19 大流行的第一年，出现缺血性中风的患者比例持续下降，治疗再次出现延误，后期波中院内死亡的风险增加。这些发现支持了鼓励在大流行期间寻求医疗急救的公共卫生信息，中风系统应重新评估协议以减轻效率低下的问题。
