Background

The novel coronavirus disease 2019 (COVID-19) outbreak raised concerns over healthcare systems’ ability to provide suitable care to stroke patients. In the present study, we examined the provision of stroke care in Kobe City during the COVID-19 epidemic, where some major stroke centers ceased to provide emergency care.

Methods

This was a cross-sectional study. The Kobe Stroke Network surveyed the number of stroke patients admitted to all primary stroke centers (PSCs) in the city between March 1 and May 23, 2020, and between March 3 and May 25, 2019. In addition, online meetings between all PSC directors were held regularly to share information. The survey items included emergency response system characteristics, number of patients with stroke hospitalized within 7 days of onset, administered treatment types (IV rt-PA, mechanical thrombectomy, surgery, and endovascular therapy), and stroke patients with confirmed COVID-19.

Results

During the period of interest in 2020, the number of stroke patients hospitalized across 13 PSCs was 813, which was 15.5% lower than that during the same period of 2019 (p = 0.285). The number of patients admitted with cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage decreased by 15.4% (p = 0.245), 16.1% (p = 0.659), and 14.0% (p = 0.715), respectively. However, the rates of mechanical thrombectomy and surgery for intracerebral hemorrhage were slightly increased by 12.1% (p = 0.754) and 5.0% (p = 0.538), respectively. PSCs that ceased to provide emergency care reported a decrease in the number of stroke cases of 65.7% compared with the same period in 2019, while other PSCs reported an increase of 0.8%. No case of a patient with stroke and confirmed COVID-19 was reported during the study period.

Conclusion

Kobe City was able to maintain operation of its stroke care systems thanks to close cooperation among all city PSCs and a temporal decrease in the total number of stroke cases.

中文翻译：

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神户市COVID-19流行期间的中风护理系统

背景

新的冠状病毒病2019（COVID-19）爆发引起了人们对医疗系统为中风患者提供适当护理的能力的担忧。在本研究中，我们研究了在COVID-19流行期间神户市中风保健的提供情况，当时一些主要的中风中心不再提供紧急护理。

方法

这是一项横断面研究。神户中风网络调查了2020年3月1日至5月23日以及2019年3月3日至5月25日之间城市所有初级中风中心（PSC）收治的中风患者人数。此外，所有PSC主任之间的在线会议定期举行以分享信息。调查项目包括紧急情况响应系统特征，发病后7天内住院的中风患者数量，所用治疗类型（IV rt-PA，机械血栓切除术，手术和血管内治疗）以及确诊COVID-19的中风患者。

结果

在2020年感兴趣的期间，在13个PSC中住院的中风患者数量为813，比2019年同期降低了15.5％（p  = 0.285）。接受脑梗塞，脑出血和蛛网膜下腔出血的患者分别减少了15.4％（p  = 0.245），16.1％（p  = 0.659）和14.0％（p  = 0.715）。然而，机械性血栓切除术和脑出血的手术率分别增加了12.1％（p  = 0.754）和5.0％（p = 0.538）。不再提供急诊服务的PSC报告的中风病例数与2019年同期相比下降了65.7％，而其他PSC报告的上升了0.8％。在研究期间，没有报告中风患者并确认COVID-19的病例。

结论

由于所有城市PSC之间的紧密合作以及中风病例总数的短暂减少，神户市得以维持其中风护理系统的运行。