AUTHOR=Gu Shiyuan , Li Jie , Shen Huachao , Dai Zhengze , Bai Yongjie , Zhang Shuai , Zhao Hongyi , Zhou Suiyun , Yu Yan , Tang Wuzhuang 

TITLE=The impact of COVID-19 pandemic on treatment delay and short-term neurological functional prognosis for acute ischemic stroke during the lockdown period

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.998758

DOI=10.3389/fneur.2022.998758

ISSN=1664-2295

ABSTRACT=Background: Preventive strategies implemented during COVID-19 pandemic may negatively influence the management of patients with acute ischemic stroke (AIS). Now studies have demonstrated that the pandemic has led to a delay in treatment among AIS patients. Whether this delay contributes to meaningful short-term outcome differences warranted further exploration.
Objective: The object of this study was to evaluate the impacts of COVID-19 pandemic on treatment delay and short-term outcome of AIS patients treated with IVT and MT.
Methods: The enrolled participants were screened to collect sociodemographic data, medical history information, and symptom onset status. Patients admitted before and after the COVID-19 pandemic outbreak were screened to compared for treatment delay. The patients treated by IVT or MT were compared with delay time and the neurological function outcome. Multivariable logistic regression was used to estimate the effect of treatment delay with short-term neurological prognosis. 
Results: In this study, 358 patients receiving IVT were included. The median admission NIHSS score (IQR) was 9 (6–13) before vs 11 (7–15) after the pandemic, (p = 0.020). DNT increased from 50 min (IQR 40–75) before to 65 min (IQR 48–84) (p = 0.048). The DPT of patients receiving MT was 120 (112-148) minutes vs 160 (125-199) minutes before and after the pandemic, p = 0.002. The post-COVID-19 group underwent a substantial delay due to the need for additional PPE (p < 0.001), viral nucleic acid testing (P < 0.001), and chest CT scans (p < 0.001). Compared to pre-pandemic, patients during the pandemic had an OR: 1.10 (95% CI, 1.03–1.30) for spontaneous intracranial hemorrhage, and an OR: 0.90 (95% CI, 0.78–0.99) for mRS  0-2 at discharge. In this study, higher NIHSS score at admission OR: 2.84 (1.45-4.8), p < 0.001, admission during the lockdown period OR: 1.22 (1.02-1.34), p = 0 .050, were significantly associated with poor outcome in AIS (mRS ≥ 3) by logistic regression.
Conclusions: COVID-19 pandemic has remarkable impacts on the management of AIS. The pandemic might exacerbate certain time delays and played a significant role in early adverse outcomes in AIS patients.