ABSTRACT
Introduction: The Sentinel Stroke National Audit Programme (SSNAP) includes a biennial 'snap-shot' of the organisation of stroke services in acute hospitals in England, Wales, and Northern Ireland. The timing of the 2019 and 2021 audits, before and during the COVID-19 pandemic, provides an opportunity to assess its impact on acute stroke care services. Method(s): A web-based proforma was sent to eligible acute hospitals requesting details of the organisation of acute stroke care services on 3rd June,2019 and 1st October,2021. In 2019, 183 acute services representing 4,847 acute beds were included. In 2021, 182 acute services were included representing 4,707 acute beds. This represents 100% participation of eligible providers. Result(s): 82% of sites (128/157) made changes in response to COVID-19 and as of October 1st, 2021, 90% reported that these changes remained in place. The number of sites reaching minimum staffing levels in several criteria fell. The availability of band 6 or 7 specialist nurses per ten beds at weekends reduced (58%-46%, p=0.03), and sites with at least one stroke consultant vacancy rose to 52%. Hospitals with a qualified psychologist on the acute unit remained low (7%-9%). A decrease was seen in sites meeting the minimum number of nurses on duty at the weekend (30%-23%,p=0.13). Conclusion(s): A large majority of sites made changes in service provision due to COVID-19 and many of these remained in place in October 2021. Reductions in the number and availability of senior clinical staff over the pandemic are reflected in these changes over time, which may have implications for the recovery of services.
ABSTRACT
Background: The COVID-19 pandemic has been reported as affecting the quality and outcomes of stroke care around the world. The impact of the first and second waves of the pandemic in the UK are compared. Methods: Data were extracted from the Sentinel Stroke National Audit Programme database of stroke admissions in England, Wales and Northern Ireland. Care quality and outcomes for 72,698 patients admitted during the first (1 March - 30 June 2020) and second (27 September 2020 - 31 March 2021) pandemic waves were compared. Results: From the first to second wave, there was an increase in mild strokes admitted (40.3% to 41.3%;p=0.002) and median NIHSS on arrival decreased (5 vs 4, p<0.001). The second wave was characterised by a decrease in direct stroke unit admission (79.8% to 76.6% ;p<0.001). Time to initial assessment by all specialists increased. Time to stroke consultant assessment increased by 34 minutes (262 vs 296 minutes;p<0.001). Complications (pneumonia: 8.6% to 9.4%, UTI: 3.3% to 3.9%;both p < 0.001) and in-hospital mortality (10.6% to 12.4%;p<0.001) increased significantly. Moderate and moderately-severe disability were more prevalent at discharge (18.1 to 18.6%, 18.3% to 19.9% respectively;p<0.001). Early supported discharge increased from 39.1% to 44.5% (p>0.001). Conclusions: Hospital avoidance by patients with mild stroke seen in the first wave was not replicated in the second wave. COVID-19 pressures on hospitals in the second wave appeared to result in fewer direct stroke unit admissions, delays in acute assessment, more complications, and more in-hospital deaths. (Figure Presented).
ABSTRACT
Purpose The COVID-19 pandemic represents a major global health burden, and an important cause of morbidity and mortality nowadays. Data remains scarce on COVID-19 in lung transplant recipients (LTR). The purpose of this study was to understand impact of infection with COVID-19 in this population, to investigate different variables that contributed to the prognosis, and to assess the long-term clinical outcomes. This represents the largest cohort of continuously followed LTR with COVID-19 to date. Methods We conducted an observational retrospective cohort study of LTRs infected with COVID 19 at a major transplant center between June 2020 and April 2021. Infection was defined by having a positive diagnostic polymerase chain reaction (PCR) test. Patients’ characteristics, COVID severity and management were retrieved. Changes in individual patient's FEV1, imaging and trans-bronchial lung biopsies (TBLB) performed at 3, 6, and 12 month intervals after infection were compared to the baseline prior to infection. Results Fifty-three LTRs were identified as having COVID infection. Median age was 64 years, 31 (58.5%) were males, and 48 (90.5%) were double-LTR. Average BMI was 26.71 and 9 patients had diabetes. 38 (71.7%) patients were on three immunosuppression agents, and 4 (7.5%) patients had an augmented immunosuppression prior to COVID infection. 7 (13.2%) patients had at least one dose of mRNA COVID vaccine. 29 (54.7%) patients were treated as outpatient. Among admitted patients, 13 (24.5%) were treated in the ICU, and 7 (13.2%) required mechanical ventilation. Mortality rate was 15.1%. 26 patients had follow up on their FEV1 in 3 months, 33 in 6 months, and 7 up to 12 months. 14 (26.4%) patients had at least >10% drop in their FEV1, of which 10 patients had >20% drop. 18 patients had TBLB in 3 months, 19 in 6 months, and 4 in 12 months. Overall, 7 (13.2%) patients had acute cellular rejections (ACR). 23 patients had chest imaging at time of infection, with CT scan available for 10. Out of these, 6 showed pure ground glass opacities (GGO), and 4 showed mixed GGO and nodular opacities. Conclusion Out of our 53 LTR with COVID infection, 24.5% had severe disease. Mortality was high in our cohort at 15.1%. PFT decline was common, with 26.4% having an FEV1 drop of over 10% at follow up, suggesting persistent complications are common.