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Published on: January 18, 2018
Delays in Stroke Onset to Hospital Arrival Time During COVID-19
Kay-Cheong Teo1, William C Y Leung1, Yuen-Kwun Wong1
1Division of Neurology, Department of Medicine (K.-C.T., W.C.Y.L., Y.-K.W., R.K.C.L., A.H.Y.C., K.-K.L., M.-Y.T., R.T.F.C., K.K.L.), Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong.
Insights
During COVID-19, stroke patients experienced longer delays in reaching the hospital, with fewer arriving within the critical 4.5-hour window. Public awareness campaigns on stroke symptoms are crucial during pandemics.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic has significantly impacted global healthcare systems.
- Disruptions to emergency services may affect time-sensitive conditions like stroke.
Purpose of the Study:
- To investigate the effect of COVID-19 on stroke presentation times.
- To assess changes in acute stroke service delivery during the pandemic.
Main Methods:
- Retrospective review of stroke and transient ischemic attack patients at a Hong Kong comprehensive stroke center.
- Comparison of data from the first 60 days of COVID-19 (2020) with the same period in 2019 (pre-COVID-19).
- Analysis of stroke onset-to-door times and inpatient pathway metrics.
Main Results:
- A total of 73 patients were analyzed during COVID-19 and 89 pre-COVID-19.
- Median stroke onset-to-door time increased by approximately 1 hour during COVID-19 (154 vs. 95 minutes).
- The proportion of patients arriving within 4.5 hours decreased significantly (55% vs. 72%), and transient ischemic attack presentations were fewer (4% vs. 16%).
Conclusions:
- The early COVID-19 pandemic phase was associated with prolonged stroke onset-to-hospital arrival times.
- Fewer patients presented with transient ischemic attack or within the critical 4.5-hour window.
- Continued public education on recognizing stroke symptoms is vital during public health crises.
Background And Purpose:
The current coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis, disrupting emergency healthcare services. We determined whether COVID-19 has resulted in delays in stroke presentation and affected the delivery of acute stroke services in a comprehensive stroke center in Hong Kong.
Methods:
We retrospectively reviewed all patients with transient ischemic attack and stroke admitted via the acute stroke pathway of Queen Mary Hospital, Hong Kong, during the first 60 days since the first diagnosed COVID-19 case in Hong Kong (COVID-19: January 23, 2020-March 24, 2020). We compared the stroke onset to hospital arrival (onset-to-door) time and timings of inpatient stroke pathways with patients admitted during the same period in 2019 (pre-COVID-19: January 23, 2019-March 24, 2019).
Results:
Seventy-three patients in COVID-19 were compared with 89 patients in pre-COVID-19. There were no significant differences in age, sex, vascular risk factors, nor stroke severity between the 2 groups (P>0.05). The median stroke onset-to-door time was ≈1-hour longer in COVID-19 compared with pre-COVID-19 (154 versus 95 minutes, P=0.12), and the proportion of individuals with onset-to-door time within 4.5 hours was significantly lower (55% versus 72%, P=0.024). Significantly fewer cases of transient ischemic attack presented to the hospital during COVID-19 (4% versus 16%, P=0.016), despite no increase in referrals to the transient ischemic attack clinic. Inpatient stroke pathways and treatment time metrics nevertheless did not differ between the 2 groups (P>0.05 for all comparisons).
Conclusions:
During the early containment phase of COVID-19, we noted a prolongation in stroke onset to hospital arrival time and a significant reduction in individuals arriving at the hospital within 4.5 hours and presenting with transient ischemic attack. Public education about stroke should continue to be reinforced during the COVID-19 pandemic.
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