Background

The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran.

Methods

This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model.

Results

During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001).

Conclusion

In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admission rates for milder stroke may possibly be due to fear of exposure related to COVID-19. The decrease in patients treated with thrombolysis and the increased disability at discharge may indicate changes in the delivery of stroke care and increased pressure on existing stroke acute and subacute services. The results of this research will contribute to a similar analysis of the larger CASCADE dataset in order to confirm findings at a global scale and improve measures to ensure the best quality of care for stroke patients during the COVID-19 pandemic.

中文翻译：

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伊朗Zanjan省COVID-19大流行期间的中风护理趋势。来自CASCADE计划：统计分析计划和初步结果

背景

COVID-19大流行的出现已严重影响了全球医疗保健系统，这可能会影响中风护理和预后。这项研究调查了伊朗赞詹省COVID-19大流行期间中风流行病学和护理的变化。

方法

这项研究是CASCADE国际计划的一部分。从2019年2月18日到2020年7月18日，我们追踪了伊朗Zanjan的Valiasr医院的缺血性和出血性中风住院率和转归。我们使用贝叶斯分层模型和间断时间序列分析（ITS）来识别中风住院率，基线中风严重度[由美国国立卫生研究院中风量表（NIHSS）测量]，残疾[经修订的Rankin量表（ mRS）]，就诊时间（最近一次到医院就诊正常），溶栓治疗率，门到针的中位时间，住院时间和住院死亡率。我们使用Cox回归模型比较了研究期间的住院死亡率。

结果

在研究期间，有1,026名中风患者住院。每10万人口的中风住院率从大流行前的68.09下降到大流行期间的44.50，贝叶斯病[Beta：-1.034; 标准误差（SE）：0.22，95％CrI：-1.48，-0.59]和ITS分析（​​估计值：-1.03，SE = 0.24，p  <0.0001）。此外，我们观察到轻度（NIHSS <5）缺血性卒中患者的入院率较低（p  <0.0001）。尽管在大流行期间，出诊时间和从门到针的时间没有改变，但是接受溶栓治疗的患者比例较低（-10.1％；p = 0.004）。我们没有发现卒中单元的入院率和院内死亡率有显着变化。但是，出院时的残疾增加了（p  <0.0001）。

结论

在伊朗的赞詹，COVID-19大流行严重影响了中风预后并改变了中风护理的提供。观察到的轻度中风入院率较低，可能是由于担心与COVID-19相关的暴露。接受溶栓治疗的患者人数减少，出院时残疾增加，可能表明卒中治疗的提供方式发生了变化，并且现有卒中急性和亚急性服务的压力增加。这项研究的结果将有助于对较大的CASCADE数据集进行类似的分析，以便在全球范围内确认发现并改善措施，以确保COVID-19大流行期间中风患者的最佳护理质量。