Delayed Stroke Treatment during COVID-19 Pandemic in China

  1. Shiyuan Gu
  2. Zhengze Dai
  3. Huachao Shen
  4. Yongjie Bai
  5. Xiaohao Zhang
  6. Xinfeng Liu
  7. Gelin Xu

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Abstract

<b><i>Background:</i></b> Social distance, quarantine, pathogen testing, and other preventive strategies implemented during CO­VID-19 pandemic may negatively influence the management of acute ischemic stroke (AIS). <b><i>Objective:</i></b> The current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of AIS in China. <b><i>Methods:</i></b> This study included patients with AIS admitted in 2 hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 pandemic outbreak (January 31, 2020, as officially announced by the Chinese government) were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records and compared for pre- (measured as onset-to-door time [ODT]) and posthospital delay (measured as door-to-needle time [DNT]). The influencing factors for delayed treatment (indicated as onset-to-needle time &#x3e;4.5 h) were analyzed with multivariate logistic regression analysis. <b><i>Results:</i></b> A total of 252 patients were included, of which 153 (60.7%) were enrolled before and 99 (39.3%) after the COVID-19 pandemic. ODT increased from 202 min (interquartile range [IQR] 65–492) before to 317 min (IQR 75–790) after the COVID-19 pandemic (<i>p =</i> 0.001). DNT increased from 50 min (IQR 40–75) before to 65 min (IQR 48–84) after the COVID-19 pandemic (<i>p =</i> 0.048). The proportion of patients with intravenous thrombolysis in those with AIS was decreased significantly after the pandemic (15.4% vs. 20.1%; <i>p</i> = 0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms, small artery occlusion, and transported by other means than ambulance were associated with delayed treatment. <b><i>Conclusions:</i></b> COVID-19 pandemic has remarkable impacts on the management of AIS. Both pre- and posthospital delays were prolonged significantly, and proportion of patients arrived within the 4.5-h time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that the outcomes of stroke could be improved.

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  1. Version published to 10.1159/000517075
  2. ScreenIT

    SciScore for 10.1101/2020.11.17.20228122: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: All participants and their relatives provided written informed consent, and the study was approved by the ethics committees of the participated hospital.
    IRB: All participants and their relatives provided written informed consent, and the study was approved by the ethics committees of the participated hospital.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using SPSS 25.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Several limitations should be addressed when interpreting the results of current study. Firstly, patients were enrolled outside the epicenter of COVID-19 pandemic in China, which may have under-estimated the impacts of the pandemic on stroke management. Secondly, with the accumulation of coping experiences, the impacts of COVID-19 pandemic on stroke management may be relieved. Finally, although the impacts of COVID-19 on intravenous thrombolysis and mechanical thrombectomy were analyzed, the impacts on stroke outcomes (e.g. 90-day modified Rankin Scale) were not analyzed. In conclusion, COVID-19 pandemic has a remarkable influence on the management of acute ischemic stroke. Both pre- and post-hospital delays were prolonged significantly, and proportion of patient arrived within the 4.5-hour time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that stroke outcome could be improved in this complex time. Statement of Ethics: Subjects (or their parents or guardians) have given their written informed consent for being treated for IV tPA. The article is exempt from ethical committee approval since IV tPA is considered the standard of care for treating AIS and there has been no disclosure of the patients’ information in this article.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.11.17.20228122v1 on medRxiv