In 2020, the COVID-19 pandemic affected health care procedures globally, including the diagnosis and treatment of acute strokes. Two outbreaks occurred in Dalian, one on July 22 and the other on December 15, 2020, eliciting an enormous governmental response to control the spread of the disease. AIS is a common cerebrovascular disease for which treatment is aimed at promptly re-establishing cerebral perfusion and avoiding ischemic necrosis within the ischemic penumbra (5). Therefore, the outcomes are highly time dependent. During the 2020 COVID-19 pandemic, epidemiological investigation and screening, among other factors, delayed the diagnosis and treatment of several patients with AIS.
The number of patients with AIS who underwent intravenous thrombolysis was significantly higher in 2021 (133.9%) than in the same period in 2020. Treatment of patients with AIS who underwent intravenous thrombolysis was unaffected by the COVID-19 pandemic. This is likely related to the strengthening of stroke health management, science popularization, and education provided by the National Brain Prevention Commission as well as by government departments and medical practitioners at all levels. Through initial adherence to publicity and educational efforts, stroke awareness by patients and their family members increased, as did the treatment rates.
When we compared patients from the same period in two different years, we observed no significant differences in age, sex, or intravenous thrombolytic drugs. However, in 2020, DNT was prolonged, exceeding the average DNT of 45 min in China and the United States (6). In addition to the signing of informed consent and other procedures (7), this increase was related to the increased surveillance of fever during the COVID-19 pandemic. This in-hospital delay could potentially have been shortened by 20 minutes if the requirement for informed consent was waived (8). Nevertheless, in the case of normalized disease prevention and control, we must consider how to shorten the in-hospital process time for patients with AIS (9).
Regardless of the pandemic, most patients with AIS with an NIHSS score ≤5 were more likely to use their own vehicles to reach the hospital than to be transported by ambulance. This is likely related to the recent increase in car ownership in China as reported by the Ministry of Public Security of China. Moreover, the stroke emergency map can be navigated such that patients can easily proceed to the nearest hospital with appropriate treatment capacity. Moreover, self-transport was used not only to avoid an uncertain waiting period for an ambulance but also to avoid concerns regarding the sanitization of ambulances during the pandemic (9). In contrast, patients with NIHSS scores ≥6 points were more likely to opt for emergency medical transport via the “120” rescue system.
Statistically significant differences were observed between the values,which the NIHSS scores of the two groups in 2020 and 2021, before and immediately after thrombolysis, were ≤5 and ≥15 points, and the NIHSS scores were 6-14 points in 2021. This indicates that more patients with AIS benefited from therapy. Such patients need to be followed-up for 1, 3, and 12 months after stroke onset to verify their prognoses.
This study has some limitations. First, the follow-up period in the present study was short. Further studies are required to confirm these results. Second, this study was retrospective and descriptive in design; therefore, our findings should be verified through prospective clinical studies. Third, all the patients who underwent intravenous thrombolysis required additional follow-up.
In summary, timely management is crucial for maximizing treatment outcomes in patients with AIS (10). Under normalized prevention and control of the COVID-19 pandemic, stroke emergency maps should be actively promoted to allow patients to choose the nearest hospital that can provide emergency treatment, whether they reach the hospital without ambulance transport or by calling “120” for assistance. Hospitals should establish efficient and high-speed green channels to help shorten the DNT, provide additional time for intravenous thrombolysis, and reduce stroke death and disability rates.