Shinoda Jun, Ichimura Saeko, Kanai Ryuichi, Majima Takamasa, Azami Shumpei, Inoue Kouji, Shirai Toshitaka
Department of Stroke, Eiju General Hospital, Tokyo, Japan.
Department of Neurosurgery, Eiju General Hospital, Tokyo, Japan.
J Neuroendovasc Ther. 2023;17(2):37-46. doi: 10.5797/jnet.oa.2022-0031. Epub 2022 Dec 14.
Protected code stroke has been widely introduced in the emergency medical system for acute stroke in the current coronavirus disease 2019 (COVID-19) pandemic. This study aims to confirm the effects of protected code stroke formulated by the Japan Stroke Society (JSS-PCS) on the quality and outcomes of reperfusion therapy for acute ischemic stroke (AIS), followed by evaluating its validity.
The subjects were 109 consecutive patients with AIS who underwent reperfusion therapy between January 2016 and July 2021, excluding in-hospital onset cases. Patients were classified according to the treatment date into the pre-COVID-19 (n = 82) and the with-COVID-19 (n = 27) groups. JSS-PCS was applied to all patients in the latter group. Statistical comparisons were made between groups on time indicators for initial treatment (onset-to-door time, door-to-imaging time [DTI], door-to-needle time [DTN], door-to-puncture time [DTP], door-to-reperfusion time, and puncture-to-reperfusion time [PTR]). The time indicator transition over the entire period was also evaluated by subgroup analysis. Subsequently, the outcomes at discharge were statistically compared between the two periods, followed by a subgroup comparison. Finally, univariate and multivariate analyses examined whether the application of JSS-PCS affected clinical outcomes.
Slight delays were revealed in DTI, DTN, DTP, and PTR in the with-COVID-19 group with no statistical significance. The time indicators were delayed once entering the period of the COVID-19 pandemic and then shortened again. The outcomes at discharge tended to worsen slightly in the with-COVID-19 group with no significance. Subgroup analysis depicted a transient deterioration of outcomes early in the pandemic. Applying JSS-PCS did not significantly affect clinical outcomes in univariate and multivariate analyses.
Regarding reperfusion therapy at our facility, the introduction and application of JSS-PCS during the COVID-19 pandemic significantly affected neither time indicators nor outcomes. Infection control should be a top priority in the first medical practice for AIS in today's world, where COVID-19 shows no signs of termination.
在当前2019冠状病毒病（COVID-19）大流行期间，急诊医疗系统中已广泛引入针对急性卒中的保护代码流程。本研究旨在确认日本卒中协会制定的保护代码流程（JSS-PCS）对急性缺血性卒中（AIS）再灌注治疗质量和结局的影响，随后评估其有效性。
研究对象为2016年1月至2021年7月期间接受再灌注治疗的109例连续AIS患者，不包括院内发病病例。根据治疗日期将患者分为COVID-19大流行前组（n = 82）和COVID-19大流行期间组（n = 27）。后一组的所有患者均应用JSS-PCS。对两组患者初始治疗的时间指标（发病至入院时间、入院至影像检查时间[DTI]、入院至穿刺时间[DTN]、入院至穿刺时间[DTP]、入院至再灌注时间以及穿刺至再灌注时间[PTR]）进行统计学比较。还通过亚组分析评估整个期间时间指标的变化。随后，对两个时期出院时的结局进行统计学比较，接着进行亚组比较。最后，通过单因素和多因素分析检验JSS-PCS的应用是否影响临床结局。
COVID-19大流行期间组的DTI、DTN、DTP和PTR出现轻微延迟，但无统计学意义。进入COVID-19大流行期后时间指标出现延迟，随后又再次缩短。COVID-19大流行期间组出院时的结局略有恶化趋势，但无显著性差异。亚组分析显示大流行早期结局有短暂恶化。在单因素和多因素分析中，应用JSS-PCS对临床结局无显著影响。
关于我们机构的再灌注治疗，在COVID-19大流行期间引入和应用JSS-PCS对时间指标和结局均无显著影响。在当今COVID-19尚无终止迹象的世界，感染控制应是AIS首次医疗实践中的首要任务。
