key: cord-0885499-dn18pmx4 authors: Xu, G.; Gu, S. title: Delayed Stroke Treatment during COVID-19 Pandemic in China date: 2020-11-18 journal: nan DOI: 10.1101/2020.11.17.20228122 sha: a0e635af3c3f98b2c5c45769ba4ea123d8a94f27 doc_id: 885499 cord_uid: dn18pmx4 Background: Social distance, quarantine, pathogen testing and other preventive strategies implemented during COVID-19 pandemic may negatively influence the management of acute stroke. Objective: The current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of acute stroke in China. Methods: This study included patients with acute stroke admitted in two hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 epidemic outbreak (January 31, 2020, as officially announced by Chinese government) were compared for pre- (measured as onset-to-door time) and post-hospital delay (measured as door-to-needle time). The influence factors for delayed treatment (indicated as onset-to-needle time >4.5 hours) were analyzed with multivariate logistic regression analysis. Results: Onset-to-door time increased from 202 min (IQR 65-492) before to 317 min (IQR 75-790) after the COVID-19 pandemic (P=0.001). Door-to-needle time increased from 50min (IQR 40-75) before to 65 min (IQR 48-84) after the COVID-19 pandemic (P=0.048). The proportion of patients with intravenous thrombolysis in those with acute ischemic stroke was decreased significantly after the pandemic (15.4% vs 20.1%; P=0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms and transported by other means than ambulance were associated with delayed treatment. Conclusions: COVID-19 pandemic has remarkable impacts 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 the outcomes of stroke could be improved. 1 becoming medical routines, efforts are warranted to shorten the delay so that the 2 6 outcomes of stroke could be improved. Table 3 presents the potential influencing factors for delayed treatment 1 2 6 (ONT>4.5h) by multivariate logistic regression analysis. Compared with patients 1 2 7 before COVID-19 pandemic, patients after COVID-19 pandemic had an OR of 1.52 1 2 8 (95% CI, 1.02-2.94) for treatment delay. Compared with patients with advanced 1 2 9 education, those with elementary education had an odds of 1.41 (95% CI, 1.08-2.31) 1 3 0 for treatment delay. Compared with patients living in urban, those living in rural area 1 3 1 had an odds of 1.20 (95% CI, 1.01-1.42) for treatment delay. Patients who firstly 1 3 2 chose to self-manage stroke after onset had an OR of 2.03 (95% CI, 1.40-3.76) for 1 3 3 treatment delay. Patients transported by EMS had an OR of 0.76 (95% CI, 0.68-0.86) 1 3 4 for treatment delay. Patients with baseline NIHSS >10 had an OR of 0.64 (95% CI, 1 3 5 0.45-0.89) for treatment delay. 1 3 6 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted November 18, 2020. ; https://doi.org/10.1101 https://doi.org/10. /2020 Discussion 1 3 7 The current study highlights the impact of COVID-19 pandemic on treatment delay in 1 3 8 patients with acute stroke. ODT and DTN were significantly prolonged, and 1 3 9 proportion of patients arrived within the time window for intravenous thrombolysis 1 4 0 was significantly decreased after COVID pandemic. During the COVID-19 pandemic, the onset to needle time was significantly 1 4 8 prolonged than before. Traffic control during the pandemic may delay the patient 1 4 9 transportation. Social distance may influence the management of stroke patients. Procedures for COVID-19 prevention, such as information inquiring concerning 1 5 1 travel and contact history, temperature measuring, chest X-ray or CT scanning, 1 5 2 coronavirus nucleic acid or antibody testing, blood cell counting, and 1 5 3 multidisciplinary consultation may all delay the management of stroke. On the other 1 5 4 hand, medical staff may need more time to wear protective devices before they could 1 5 5 manage stroke patients during the COVID-19 pandemic. This study associated higher NIHSS score with shorter pre-hospital delay. This 1 5 7 is consistent with some previous studies [7, 8] , but not with others [9]. Patients with 1 5 8 severe symptoms may be more obvious to be identified, but severe symptoms may 1 5 9 render patients from seeking for help when alone. Transferred with ambulance was 1 6 0 associated with shorter pre-hospital delay [10] [11] [12] [13] . Early awareness of stroke onset 1 6 1 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted November 18, 2020. ; https://doi.org/10.1101/2020.11.17.20228122 doi: medRxiv preprint All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted November 18, 2020. ; https://doi.org/10.1101 https://doi.org/10. /2020 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted November 18, 2020. ; https://doi.org/10. 1101 /2020 ONT indicates onset-to-needle time; OR, odds ratio; CI, confidence interval; NIHSS, National Institutes of Health Stroke Scale. All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted November 18, 2020. ; https://doi.org/10. 1101 /2020 Age, year, mean 69 Male gender, n (%) Stroke history, n (%)