Article Text
Abstract
Background The COVID-19 pandemic and physical distancing guidelines have compelled stroke practices worldwide to reshape their delivery of care significantly. We aimed to illustrate how the stroke services were interrupted during the pandemic in China.
Methods A 61-item questionnaire designed on Wenjuanxing Form was completed by doctors or nurses who were involved in treating patients with stroke from 1 February to 31 March 2020.
Results A total of 415 respondents completed the online survey after informed consent was obtained. Of the respondents, 37.8%, 35.2% and 27.0% were from mild, moderate and severe epidemic areas, respectively. Overall, the proportion of severe impact (reduction >50%) on the admission of transient ischaemic stroke, acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH) was 45.0%, 32.0% and 27.5%, respectively. Those numbers were 36.9%, 27.9% and 22.3%; 36.5%, 22.1% and 22.6%; and 66.4%, 47.5% and 41.1% in mild, moderate and severe epidemic areas, respectively (all p<0.0001). For AIS, thrombolysis was moderate (20%–50% reduction) or severely impacted (>50%), as reported by 54.4% of the respondents, while thrombectomy was 39.3%. These were 44.4%, 26.3%; 44.2%, 39.4%; and 78.2%, 56.5%, in mild, moderate and severe epidemic areas, respectively (all p<0.0001). For patients with acute ICH, 39.8% reported the impact was severe or moderate for those eligible for surgery who had surgery. Those numbers were 27.4%, 39.0% and 58.1% in mild, moderate and severe epidemic areas, respectively. For staff resources, about 20% (overall) to 55% (severe epidemic) of the respondents reported moderate or severe impact on the on-duty doctors and nurses.
Conclusion We found a significant reduction of admission for all types of patients with stroke during the pandemic. Patients were less likely to receive appropriate care, for example, thrombolysis/thrombectomy, after being admitted to the hospital. Stroke service in severe COVID-19 epidemic areas, for example, Wuhan, was much more severely impacted compared with other regions in China.
- stroke
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Footnotes
XW and MO contributed equally.
Contributors XW, MO, LS,YW, DW and CA contributed to study concept and overall design; CCa, LS, JY, YZ, GC, SY, YC, LM, HX, YS and CCh contributed to the questionnaire development and data acquisition. XW and MO contributed to data analysis and manuscript writing. All authors critically reviewed and approved the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests CA reports receiving fees for Advisory Panels of Astra Zeneca and Medtronic, speaking at seminars for Takeda China and Boehringer Ingelheim, and a research grant from Takeda China.
Patient consent for publication Not required.
Ethics approval Considering the low risk and anonymity of the participants, we simply obtained the informed consent. After reading the opening statement at the beginning of the questionnaire, the respondents would be directed to answer questions only if they are willing to participate. Otherwise, the survey would be ended. Data collection complied with Wenjuanxing terms and conditions.
Provenance and peer review Commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Individual deidentified participant data used in these analyses can be shared by formal request with protocol and statistical analysis plan from any qualified investigator to the Research Office of The George Institute for Global Health, Australia. A tailored dataset specific to the research question will be shared for 6 months, and the data can be only accessed by qualified statisticians for the proposed analysis.