Impact of COVID-2019 on stroke services in China: survey from the Chinese Stroke Association

Authors

Xia Wang, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Menglu Ouyang, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Cheryl Carcel, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Chen Chen, Department of Neurology, Shanghai East Hospital, Shanghai, Shanghai, China.
Lingli Sun, Stroke Division, The George Institute China at Peking University Health Science Centre, Beijing, PR China, Shanghai, China.
Jie Yang, Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
Yao Zhang, Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China.
Guofang Chen, Department of Neurology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
Shoujiang You, Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Yongjun Cao, Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Lu Ma, Department of Neurosurgery, West China Hospital of Medicine, Chengdu, Sichuan, China.
Xin Hu, Department of Neurosurgery, West China Hospital of Medicine, Chengdu, Sichuan, China.
Yi Sui, Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China.
Craig Anderson, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Lili Song, Stroke Division, The George Institute China at Peking University Health Science Centre, Beijing, PR China, Shanghai, China lsong@georgeinstitute.org.cn yongjunwang111@aliyun.com.
Yongjun Wang, Department of Neurology, China National Clinical Research Center for Neurological Disease, Beijing, China lsong@georgeinstitute.org.cn yongjunwang111@aliyun.com.
David Wang, Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow

Document Type

Article

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.

Medical Subject Headings

COVID-19 (epidemiology); Cerebral Hemorrhage (epidemiology); China (epidemiology); Cross-Sectional Studies; Health Services (statistics & numerical data); Humans; Ischemic Attack, Transient (epidemiology); Ischemic Stroke (epidemiology); Neurosurgery (statistics & numerical data); Pandemics; Patient Admission (statistics & numerical data); Patient Care Management; Stroke (epidemiology, surgery, therapy); Surveys and Questionnaires; Thrombolytic Therapy (statistics & numerical data)

Publication Date

12-1-2020

Publication Title

Stroke and vascular neurology

E-ISSN

2059-8696

Volume

5

Issue

4

First Page

323

Last Page

330

PubMed ID

32989012

Digital Object Identifier (DOI)

10.1136/svn-2020-000514

Recommended Citation

Wang, Xia; Ouyang, Menglu; Carcel, Cheryl; Chen, Chen; Sun, Lingli; Yang, Jie; Zhang, Yao; Chen, Guofang; You, Shoujiang; Cao, Yongjun; Ma, Lu; Hu, Xin; Sui, Yi; Anderson, Craig; Song, Lili; Wang, Yongjun; and Wang, David, "Impact of COVID-2019 on stroke services in China: survey from the Chinese Stroke Association" (2020). Neurology. 1792.
https://scholar.barrowneuro.org/neurology/1792