Care Process of Recanalization Therapy for Acute Stroke during the COVID-19 Outbreak in South Korea
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background and Purpose We aimed to determine whether the care process and outcomes in patients with acute stroke who received recanalization therapy changed during the outbreak of coronavirus disease 2019 (COVID-19) in South Korea. Methods We used data from a prospective multicenter reperfusion therapy registry to compare the care process—including the time from symptom onset to treatment, number of treated patients, and discharge disposition—and treatment outcomes between before and during the COVID-19 outbreak in South Korea. Results Upon the COVID-19 outbreak in South Korea, the number of patients receiving endovascular treatment to decrease temporarily but considerably. The use of emergency medical services by stroke patients increased from 91.5% before to 100.0% during the COVID-19 outbreak (p=0.025), as did the median time from symptom onset to hospital visit [median (interquartile range), 91.0 minutes (39.8–277.0) vs. 176.0 minutes (56.0–391.5), p=0.029]. Furthermore, more functionally dependent patients with disabilities were discharged home (59.5% vs. 26.1%, p=0.020) rather than staying in a regional or rehabilitation hospital. In contrast, there were no COVID-19-related changes in the times from the hospital visit to brain imaging and treatment or in the functional outcome, successful recanalization rate, or rate of symptomatic intracerebral hemorrhage. Conclusions These findings suggest that a prehospital delay occurred during the COVID-19 outbreak, and that patients with acute stroke might have been reluctant to visit and stay in hospitals. Our findings indicate that attention should be paid to prehospital care and the behavior of patients with acute stroke during the COVID-19 outbreak.
Abstract
Background and Purpose We aimed to determine whether the care process and outcomes in patients with acute stroke who received recanalization therapy changed during the outbreak of coronavirus disease 2019 (COVID-19) in South Korea. Methods We used data from a prospective multicenter reperfusion therapy registry to compare the care process—including the time from symptom onset to treatment, number of treated patients, and discharge disposition—and treatment outcomes between before and during the COVID-19 outbreak in South Korea. Results Upon the COVID-19 outbreak in South Korea, the number of patients receiving endovascular treatment to decrease temporarily but considerably. The use of emergency medical services by stroke patients increased from 91.5% before to 100.0% during the COVID-19 outbreak (p=0.025), as did the median time from symptom onset to hospital visit [median (interquartile range), 91.0 minutes (39.8–277.0) vs. 176.0 minutes (56.0–391.5), p=0.029]. Furthermore, more functionally dependent patients with disabilities were discharged home (59.5% vs. 26.1%, p=0.020) rather than staying in a regional or rehabilitation hospital. In contrast, there were no COVID-19-related changes in the times from the hospital visit to brain imaging and treatment or in the functional outcome, successful recanalization rate, or rate of symptomatic intracerebral hemorrhage. Conclusions These findings suggest that a prehospital delay occurred during the COVID-19 outbreak, and that patients with acute stroke might have been reluctant to visit and stay in hospitals. Our findings indicate that attention should be paid to prehospital care and the behavior of patients with acute stroke during the COVID-19 outbreak.
참고문헌 (21)
- Donnan GA, "Stroke", Lancet, 371, pp.1612~1623 (2008)
- Goyal M, "Endovascular thrombectomy after large-vessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials", Lancet, 387, pp.1723~1731 (2016)
- Powers WJ, "Guidelines for the early management of patients with acute ischemic stroke : 2019 update to the 2018 guidelines for the early management of acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2019, pp.50, e344~
- Kim YD, "Improving the clinical outcome in stroke patients receiving thrombolytic or endovascular treatment in Korea : from the SECRET study", J Clin Med, 9, pp.717~ (2020)
- Jun Yup Kim, "Executive Summary of Stroke Statistics in Korea 2018: A Report from the Epidemiology Research Council of the Korean Stroke Society", 대한뇌졸중영문학회지, 21(1), pp.42~59 (2019), 대한뇌졸중학회[DOI]
- Dongbeom Song, "Factors Associated with Early Hospital Arrival in Patients with Acute Ischemic Stroke", 대한뇌졸중영문학회지, 17(2), pp.159~167 (2015), 대한뇌졸중학회
- Goyal M, "Prehospital triage of acute stroke patients during the COVID-19 pandemic", Stroke, 51, pp.2263~2267 (2020)
- Saver JL, "Time is brain--quantified", Stroke, 37, pp.263~266 (2006)
- Shkirkova K, "Frequency, predictors, and outcomes of prehospital and early postarrival neurological deterioration in acute stroke : exploratory analysis of the FAST-MAG randomized clinical trial", JAMA Neurol, 75, pp.1364~1374 (2018)
- Myoung-don Oh, "Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea", The Korean Journal of Internal Medicine, 33(2), pp.233~246 (2018), 대한내과학회[DOI]
- Kerleroux B, "Mechanical thrombectomy for acute ischemic stroke amid the COVID-19 outbreak : decreased activity, and increased care delays", Stroke, 51, pp.2012~2017 (2020)
- Rudilosso S, "Acute stroke care is at risk in the era of COVID-19 : experience at a comprehensive stroke center in Barcelona", Stroke, 51, pp.1991~1995 (2020)
- Zhao J, "Impact of the COVID-19 epidemic on stroke care and potential solutions", Stroke, 51, pp.1996~2001 (2020)
- Khosravani H, "Protected code stroke : hyperacute stroke management during the coronavirus disease 2019(COVID-19)pandemic", Stroke, 51, pp.1891~1895 (2020)
- Ki Tae Kwon, "Drive-Through Screening Center for COVID-19: a Safe and Efficient Screening System against Massive Community Outbreak", Journal of Korean Medical Science, 35(11), pp.1~4 (2020), 대한의학회[DOI]
- 김범준, "Management of Acute Stroke Patients Amid the Coronavirus Disease 2019 Pandemic: Scientific Statement of the Korean Stroke Society", 대한뇌졸중영문학회지, 22(2), pp.203~205 (2020), 대한뇌졸중학회[DOI]
- Leira EC, "Preserving stroke care during the COVID-19 pandemic : potential issues and solutions", Neurology, 95, pp.124~133 (2020)
- Oxley TJ, "Large-vessel stroke as a presenting feature of COVID-19 in the young", N Engl J Med, 382, pp.e60~ (2020)
- Pop R, "Impact of the COVID-19 outbreak on acute stroke pathways-insights from the Alsace region in France", Eur J Neurol, 27, pp.1783~1787 (2020)
- Qureshi AI, "Management of acute ischemic stroke in patients with COVID-19 infection : report of an international panel", Int J Stroke, 15, pp.540~554 (2020)
- Teo KC, "Delays in stroke onset to hospital arrival time during COVID-19", Stroke, 51, pp.2228~2231 (2020)