1 becoming medical routines, efforts are warranted to shorten the delay so that the 2 6 outcomes of stroke could be improved. Table 3 presents the potential influencing factors for delayed treatment 1 2 6 (ONT>4.5h) by multivariate logistic regression analysis. Compared with patients 1 2 7 before COVID-19 pandemic, patients after COVID-19 pandemic had an OR of 1.52 1 2 8 (95% CI, 1.02-2.94) for treatment delay. Compared with patients with advanced 1 2 9 education, those with elementary education had an odds of 1.41 (95% CI, 1.08-2.31) 1 3 0 for treatment delay. Compared with patients living in urban, those living in rural area 1 3 1 had an odds of 1.20 (95% CI, 1.01-1.42) for treatment delay. Patients who firstly 1 3 2 chose to self-manage stroke after onset had an OR of 2.03 (95% CI, 1.40-3.76) for 1 3 3 treatment delay. Patients transported by EMS had an OR of 0.76 (95% CI, 0.68-0.86) 1 3 4 for treatment delay. Patients with baseline NIHSS >10 had an OR of 0.64 (95% CI, 1 3 5 0.45-0.89) for treatment delay. 1 3 6 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this this version posted November 18, 2020. ; https://doi.org/10.1101 https://doi.org/10. /2020 Discussion 1 3 7
The current study highlights the impact of COVID-19 pandemic on treatment delay in 1 3 8 patients with acute stroke. ODT and DTN were significantly prolonged, and 1 3 9
proportion of patients arrived within the time window for intravenous thrombolysis 1 4 0 was significantly decreased after COVID pandemic. During the COVID-19 pandemic, the onset to needle time was significantly 1 4 8 prolonged than before. Traffic control during the pandemic may delay the patient 1 4 9 transportation. Social distance may influence the management of stroke patients. Procedures for COVID-19 prevention, such as information inquiring concerning 1 5 1 travel and contact history, temperature measuring, chest X-ray or CT scanning, 1 5 2 coronavirus nucleic acid or antibody testing, blood cell counting, and 1 5 3 multidisciplinary consultation may all delay the management of stroke. On the other 1 5 4 hand, medical staff may need more time to wear protective devices before they could 1 5 5 manage stroke patients during the COVID-19 pandemic. This study associated higher NIHSS score with shorter pre-hospital delay. This 1 5 7 is consistent with some previous studies [7, 8] , but not with others [9]. Patients with 1 5 8 severe symptoms may be more obvious to be identified, but severe symptoms may 1 5 9 render patients from seeking for help when alone. Transferred with ambulance was 1 6 0 associated with shorter pre-hospital delay [10] [11] [12] [13] . Early awareness of stroke onset 1 6 1 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this this version posted November 18, 2020. ; https://doi.org/10.1101/2020.11.17.20228122 doi: medRxiv preprint All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this this version posted November 18, 2020. ; https://doi.org/10.1101 https://doi.org/10. /2020 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this this version posted November 18, 2020. ; https://doi.org/10. 1101 /2020 ONT indicates onset-to-needle time; OR, odds ratio; CI, confidence interval; NIHSS, National Institutes of Health Stroke Scale.
All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this this version posted November 18, 2020. ; https://doi.org/10. 1101 /2020 